REPRODUCTIVE ENDOCRINOLOGY

Resolution of the Vi International Forum of Experts on Menopausal Hormone Therapy

Mon, 31 Mar 2025 00:00:00 +0300

On November 27, 2024, the VI International Forum of Experts on Menopausal Hormone Therapy (MHT) was held with the support of the Ukrainian Association of Gynecologists-Endocrinologists. Leading specialists from Azerbaijan, Armenia, Georgia, Kazakhstan, Uzbekistan and Ukraine took part in the event. The experts reviewed the criteria for the MHT acceptance, the features of the appointment of this therapy and its safety profile in menopausal women with endometriosis, in patients with uterine fibroids, discussed new studies on menopause and the MHT.
Regarding oncological risks, there are no restrictions on the MHT use in women with ovarian and colon cancer. In women with endometrial, cervical, lung cancer, melanoma, with BRCA1 and BRCA2 gene mutations and negative HR receptors, the benefits of MHT outweigh the risks. In case of venous thromboembolism / pulmonary embolism in the anamnesis, the absence of a progestogen component in the composition of MHT is important. In patients with migraines without aura, both estrogen and combined MHT can be used. Combined MHT with metabolically neutral dydrogesterone can be prescribed for tension headache. There are no contraindications to MHT in metabolic syndrome and diseases of the digestive system. MHT is limited in acute hepatitis and inflammatory bowel diseases, and contraindicated in liver cirrhosis.
When MHT interacts with other drugs, the effectiveness of estrogens and progestogens may be impaired. MHT can be used simultaneously with many drugs, with the exception of aromatase inhibitors, selective estrogen receptor modulators, anticonvulsants, antineoplastic drugs and immunosuppressive drugs.
A large number of women with endometriosis have symptoms of menopause and need MHT. Such therapy should be individualized taking into account the needs of the patient, it is necessary to take into account the possible recurrence of endometriosis and the risk of malignancy in menopause.
MHT can be prescribed for asymptomatic uterine fibroids in the absence of indications for surgical treatment. MHT is safest for «old» nodes of stable size. During the MHT an ultrasound monitoring of the nodes growth is needed and therapy should be discontinued if growth is detected.
The analysis of the MHT safety showed that ultra-low doses of estradiol and dydrogesterone have a beneficial effect on vasomotor symptoms and quality of life of postmenopausal women, are well tolerated without an increase in the frequency of side effects compared to placebo.

Prevention of recurrence of endometrial hyperplasia in premenopausal women

O.V. Kravchenko — Mon, 31 Mar 2025 00:00:00 +0300

Objective of the study: to evaluate the effectiveness of the proposed therapy aimed at preventing recurrence of endometrial hyperplasia (EH) in premenopausal patients.
Materials and methods. The study included 42 patients with EH aged 48–51 years. The diagnosis of EH was verified by clinical, instrumental and morphological methods of research. The efficacy of therapy was evaluated by performing a punch biopsy of the endometrium after 1 year of treatment and every 3 months in the dynamics of observation. In order to prevent recurrence of the disease in premenopausal age, all patients with EH received dienogest (Vigest-KV) 2 mg/day for 12 months in a continuous mode.
Results. All the women with verified EH had clinical signs of abnormal uterine bleeding. The average thickness of the endometrium in patients according to ultrasound study before treatment was 22.1 ± 2.4 mm. After the therapy, it was 5.1 ± 0.1 mm, after 3 months of follow-up – 6.4 ± 0.24 mm, 6 months after the therapy – 7.8 ± 0.35 mm. According to the results of the punch biopsy after treatment, 95.2% (40) of patients showed regression of the disease, in 4.8% (2) women there was persistence of EH. Physiological endometrium was morphologically verified in 100% of women with disease regression after 3 months of observation, disease relapse occurred in 4.2% (2) of patients after 6 months of observation.
Conclusions. The method of choice for the prevention of recurrence of EH in the premenopausal age is drugs with a peripheral mechanism of action for block ovulation, which allows maintaining estrogen levels within the therapeutic window and improves the quality of life of women without creating a state of estrogen deficiency in the body.
Long-term continuous dienogest therapy in premenopausal women with EH can reduce both the persistence of the disease and the rate of disease recurrence by up to 4.8%.

The role of mammographic findings associated with breast microcalcifications in the choice of imaging tactics

A.Y. Kovtun, T.M. Kozarenko, A.V. Gurando — Mon, 31 Mar 2025 00:00:00 +0300

ackground. Calcifications are considered the most common mammography findings, detected in 80% of cases. Although the majority of calcifications are not dangerous and represent benign changes that do not require further examination and follow-up, in one third of cases, suspicious microcalcifications (MC) are verified as malignant. In addition, MC can be identified with associated findings such as architectural distortions, asymmetries, and masses, which can further complicate imaging interpretation.
Objective of the study: to evaluate the impact of concomitant findings associated with MC on the risk of breast cancer detection.
Materials and methods. An analysis of radiological and pathomorphological studies was carried out in 129 women with suspicious MC, aged from 31 to 85 years, with an average age of 49.0 years. Sampling was performed under ultrasound and X-ray guidance, depending on the ability to visualize the suspicious area with MC.
Results. MC with associated findings (19.38%) increase the risk of detecting malignant pathology at the verification stages in comparison with suspicious MC without associated findings
(8.53%). The probability of detecting an invasive component increases, which is further confirmed by the increased frequency of visualization of these associated findings on ultrasound (18.6%) compared to the women without associated findings (6.2%), and the frequency of breast complaints in female patients. The most frequent and dangerous concomitant findings were masses (39.28%) and architectural distortions (42.85%). The probability of detecting concomitant findings associated with MC increased when visualizing suspicious MC in the upper-outer quadrant, when the size of the MC area was more than 15 mm and in the age group of elderly and geriatric patients (p < 0.05).
Conclusions. Whenever possible, physicians should immediately verify suspicious areas associated with MC. Particular attention should be paid to masses and architectural distortions associated with MC. Risks of associated findings may include the size of the MC area > 15 mm, localization in the upper-outer quadrant of the breast, and the elderly and geriatric patients.

Successful pregnancy: simply about the complicated

T.F. Tatarchuk, V.I. Pyrogova, N.P. Goncharuk, N.Y. Pedachenko, D.G. Konkov — Mon, 31 Mar 2025 00:00:00 +0300

Progesterone is a key hormone essential for maintaining pregnancy. Its deficiency can lead to the risk of miscarriage, recurrent pregnancy loss, and unsuccessful attempts at in vitro fertilization. In clinical practice, progestogens are used for luteal phase support, particularly in women with corpus luteum insufficiency or in assisted reproductive technologies cycles.
After the synthetic progestogen 17-hydroxyprogesterone caproate was withdrawn from the pharmaceutical market due to low efficacy and multiple side effects, only two effective agents remain in obstetrics and reproductive medicine – progesterone and dydrogesterone.
Dydrogesterone is a synthetic analog of natural progesterone with high oral bioavailability, making it a convenient alternative to other forms of progestogens. It selectively binds to progesterone receptors, ensuring stable endometrial support and promoting early pregnancy maintenance. Unlike some other progestogens, dydrogesterone has no androgenic, estrogenic, or glucocorticoid effects, which contributes to its better tolerability.
The evidence base supporting dydrogesterone’s efficacy includes numerous randomized controlled trials, particularly LOTUS I and LOTUS II, which demonstrated that oral dydrogesterone is as effective as vaginal progesterone for luteal phase support at in vitro fertilization cycles. Additionally, multiple meta-analyses confirm that dydrogesterone use in the first trimester significantly reduces the risk of miscarriage, and over 70 studies have confirmed the high efficacy and safety of its molecule for both women and fetuses.
The safety of dydrogesterone is particularly important. The international expert group on the safety of progestogens in early pregnancy REASSURE concluded that there is currently no basis for making statements about a causal relationship between the use of dydrogesterone in the first trimester and the risk of congenital malformations.
Thus, due to its proven efficacy and excellent safety profile, supported by over 60 years of clinical use, dydrogesterone is the optimal choice for luteal phase support in both natural cycles and assisted reproductive technologies.

Medical and social characteristics of pregnant women in armed conflict

M.I. Malachinska, N.S. Veresniuk — Mon, 31 Mar 2025 00:00:00 +0300

Objective of the study: to assess the impact of the armed conflict on the medical and social characteristics of pregnant women, focusing on financial security, educational level, psychological well-being, access to healthcare services, and the overall quality of maternal care during pregnancy. Special emphasis was focused on evaluating the effects of stress, socio-economic factors, and employment changes on the health of expectant mothers and fetal development.
Materials and methods. The study was conducted in the Lviv region and involved 1,000 pregnant women divided into three groups: group 1 – women who relocated from active combat zones; group 2 – women who moved from other regions of Ukraine during the military conflict; group 3 – a control group of local residents.
The primary methods included structured surveys, comprehensive medical examinations, and statistical analysis using chi-square tests.
Results. Pregnant women in groups 1 and 2 exhibited significantly lower levels of financial security and educational attainment compared to the control group. These groups experienced markedly higher levels of psychological stress, substandard living conditions, and reduced access to quality healthcare services. The analysis also demonstrated a higher incidence of employment termination due to health issues among displaced women. Consequently, the adverse effects of the armed conflict are reflected in multiple socio-economic and medical indicators that directly affect maternal health.
Conclusions. The study shows that the armed conflict has a profound negative impact on the medical and social characteristics of pregnant women by deteriorating their economic conditions, increasing stress levels, and limiting access to healthcare services. These findings underscore the urgent need for targeted social support programs and improvements in maternal healthcare. Implementing measures to reduce psychological burden, improve living conditions, and enhance the availability of modern medical resources should be a priority for both national and local authorities, thereby contributing to the overall well-being of expectant mothers and their children.

Women’s Health. Modern Perinatal Strategies

Editor REPRODUCTIVE ENDOCRINOLOGY — Mon, 31 Mar 2025 00:00:00 +0300

21–22 березня 2025 року в м. Чернівці на базі кафедри акушерства, гінекології та перинатології Буковинського державного медичного університету (БДМУ) була проведена Всеукраїнська науково-практична конференція «Здоров’я жінки. Сучасні перинатальні стратегії», присвячена 30-річчю заснування кафедри.

The effect of alcohol on sex hormone levels in fertile aged women with chronic inflammatory diseases caused by sexually transmitted infections

Vl.V. Podolskyi, V.V. Podolskyi, Y.M. Rybinskyі — Mon, 31 Mar 2025 00:00:00 +0300

Objective of the study: to determine the effect of alcohol consumption on the levels of sex hormones, pituitary gonadotropins, and the overall endocrine balance in women of reproductive age. Special emphasis was placed on the impact of alcohol on reproductive health and fertility, particularly in cases where alcohol consumption is accompanied by chronic inflammatory diseases (CID) caused by sexually transmitted infections.
Materials and methods. This case-control study involved the analysis of blood samples. It included 120 women of fertile age, divided into groups: 40 women with alcohol dependence and CID of reproductive system, 40 women with alcohol dependence without CID of the reproductive system, 40 healthy participants. Determination of concentrations of key hormones (follicle-stimulating and luteinizing hormones, estradiol, progesterone, cortisol and prolactin) was carried out using validated enzyme-linked immunosorbent assay systems, which allowed assessing violations of the hormonal profile and endocrine balance. Women with alcohol dependence underwent complex therapy aimed at normalizing the hormonal background.
Results. The results demonstrated that alcohol consumption leads to significant disruptions in endocrine homeostasis. Specifically, in women with alcohol dependence: follicle-stimulating hormone levels were markedly increased relative to luteinizing hormone (with follicle-stimulating hormone values approximately twice as high), there was a notable decrease in estradiol and progesterone levels, elevated levels of cortisol and prolactin. These hormonal imbalances cause reproductive dysfunctions such as anovulation, amenorrhea, and reduced fertility, adversely affecting reproductive health.
Conclusions. Alcohol consumption adversely affects the reproductive health of women of reproductive age by disrupting the balance of sex hormones and gonadotropins. Therapeutic interventions aimed at normalizing the endocrine profile can restore hormonal balance and improve reproductive function. Further research is needed to develop effective preventive and therapeutic strategies to mitigate the negative impact of alcohol on fertility and overall reproductive health.

Public health of the nation and reproductive violence

V.B. Kovalchuk, І. І. Komarnytska, O.V. Rizenko, V.M. Pasternak, I.M. Kostiukova — Mon, 31 Mar 2025 00:00:00 +0300

Background. The article examines a separate area of ensuring the reproductive health of the nation - protection of society from reproductive violence, which is broadly understood to include not only manifestations of sexual violence, but also aspects related to forced abortion, forced sterilization, legal prohibition of contraception, etc. The legal mechanism for combating reproductive violence, including public health regulations, prohibition of violence and a set of guarantees that form law-respectful behavior in the reproductive sphere, is defined.
Objective of the study: comprehensive analysis of the nation’s reproductive health problems by identifying methods and means of combating reproductive violence through legal mechanisms.
Materials and methods. The disclosure of the subject of the study requires the use of an intercomplex approach that absorbs knowledge from several areas of scientific knowledge - medicine, jurisprudence, sociology, political science, and ethics. The method of dogmatic analysis was used to study the incidents of legal proceedings related to human rights violations and institutional means of their protection; the comparative method was used to compare the role of individual means of influence on the country’s reproductive and preventive policies.
Results. The concept of reproductive violence is defined and distinguished from other related concepts; the state mechanism for combating reproductive violence as devaluing behavior that affects the reproductive health of the nation is formed; certain forms of reproductive violence are considered and the effectiveness of institutional and judicial mechanisms for combating this type of violence is determined.
Conclusions. Reproductive violence is broader than sexual violence, as it additionally includes violations of reproductive autonomy or reproductive capacity and is represented by such forms as forced pregnancy, forced sterilization, forced abortion, forced contraception, genital mutilation/circumcision, child marriage, and control over pregnancy outcomes. The analysis of the legislation and practice of a number of countries (the USA, India, Sweden, Austria, Ukraine, Ireland, France, the Netherlands, Germany, Canada, Belgium, Luxembourg, Spain, Mexico, Brazil, Malta, Portugal, etc.) has made it possible to state that reproductive health issues in the states often remain outside the focus of the lawmaker and the mechanisms for protecting human rights subjects from reproductive violence are insufficient.

Immunocytochemical screening for papillomavirus infection in women: general characteristics and justification of the feasibility

I.I. Daineko, N.V. Kosey, H.V. Vetokh, N.F. Zakharenko, S.G. Gychka — Mon, 31 Mar 2025 00:00:00 +0300

Background. Human papillomavirus (HPV) is the leading cause of cervical cancer in women. Early diagnosis of a viral lesion of the multilayer cervical squamous epithelium is extremely important for timely treatment and prevention of cancer. To diagnose papillomavirus infection and cervical lesions according to modern European and American protocols, the determination of HPV by polymerase chain reaction (PCR) and the traditional PAP test are used. An alternative method of diagnosing papillomavirus infection can be immunocytochemical (ICH) screening.
Objective of the study: to justify the feasibility of ICH screening as an alternative method for diagnosing viral lesion of the cervical epithelium.
Materials and methods. In the study cytological material from 60 patients aged 23–60 years was examined. All cases were divided into two groups: Group 1 – 30 cases from patients with HPV which was detected by PCR, Group 2 – 30 cases from patients without HPV according to PCR. All patients underwent colposcopy with taking of cytological material, ICH examination of cytological material with a BSB-66 clone of anti-HPV antibodies followed by light microscopy of the samples, PCR testing for HPV and, if necessary, pathohistological examination.
Results. The statistically significant difference between the results of ICH and PCR testing was detected: 100% of negative PCR results coincided with negative IHC results. Regarding positive cases, a coincidence was recorded in 73.33% of cases.
Conclusions. The study has shown that the ICH method of detecting HPV makes it possible to exclude the category of women who not only have persistence of the HPV, but also have its incorporation into the cells of the cervical epithelium, which may be accompanied by certain changes with the risk of developing of intraepithelial neoplasia. A greater coincidence of positive ICH reaction to HPV with abnormal colposcopy data and confirmation of the intraepithelial changes by pathohistological studies indicates the informatively of the method as a predictor of dysplastic cervical changes.