REPRODUCTIVE ENDOCRINOLOGY

Preserving pregnancy during wartime and demographic crisis in Ukraine: scientific evidence and clinical expertise in progestogen application

Editor Editor — Fri, 30 May 2025 00:00:00 +0300

Вважаємо за необхідне виступити з пропозицією запровадити в Україні єдиний міждисциплінарний підхід до надання медичної допомоги пацієнткам з невиношуванням вагітності та передчасними пологами, спираючись на результати аналізу завершених багатоцентрових рандомізованих контрольованих досліджень останніх років [1] і рекомендації чинних настанов профільних професійних асоціацій країн ЄС, Великої Британії, Австралії та США [2–10], а також, зважаючи на критичну демографічну ситуацію, що склалася в нашій країні [11].

Progestogen-resistant forms of endometrial hyperplasia without atypia. Molecular diagnostic criteria and pathogenetic therapy strategy

Fri, 30 May 2025 00:00:00 +0300

Background. Justification. The article discusses the issues of diagnosis and treatment of progestogen-resistant forms of endometrial hyperplasia without atypia, which are relevant today due to numerous negative consequences for women, namely abnormal uterine bleeding, infertility, and the risk of malignancy.

Objective of the study: Аssessment of the degree of pathological molecular changes in endometrial cells, which may act as predictors for determining an individual treatment strategy for endometrial hyperplasia without atypia in women

Materials and methods. 311 women with a histological diagnosis of endometrial hyperplasia without atypia were treated with various forms of progestogens for 6 months in a continuous mode.

Results. The absence of regression of endometrial hyperplasia without atypia or its recurrence over the next 3 years was diagnosed in 23 (23.9%) of 96 women after therapy with micronized progesterone at a dose of 200 mg/day, in 30 (18.6%) of 161 women who received 20 mg of dydrogesterone daily and in 9 (16.7%) of 54 women who received an intrauterine system with levonorgestrel as therapy. To clarify the reason for this circumstance, the expression of estrogen receptors and progesterone receptors (PGR), kinase-dependent cyclin Cdk-D1, Ki-67 protein, and glycoprotein E-cadherin was studied by immunohistochemical methods in primary and control morphological samples of the endometrium after treatment. 63 endometrial samples with negative and 48 samples with positive results of progestogen therapy were studied. It was found that in 73.02% of women with negative results of progestogen therapy, the expression of PGR was absent in the studied endometrial samples (H-index PGR < 50), in the remaining 26.98% of samples their low expression was found, both in the glands and in the stroma (H-index 53.6 ± 0.8 and 42.5 ± 0.6, respectively). On the contrary, in endometrial samples of women with regression of endometrial hyperplasia without atypia against the background of treatment with progestogens, the expression of PGR was positive in 97.92% of cases, and the average values of the PGR H-index, which were 194.1 ± 4.1 and 168.2 ± 2.1 in glandular and stroma cells, respectively, were significantly higher than in the previous sample (p < 0.05).

Therefore, adequate receptivity is a necessary condition for the implementation of the genomic-mediated mechanism of the influence of progestogens on the activity of genes that control proliferation and contribute to its inhibition. The authors believe that the lack of regression of endometrial hyperplasia under the influence of progestogens is probably associated with the features of the expression of PGR in progestogen-resistant patients. After the appointment of the gonadotropin-releasing hormone analogue goserelin acetate (Zoladex®, AstraZeneca) to such women for the next six months, regression of endometrial hyperplasia occurred in 93.8% of cases. At the molecular level, a 7.3-fold decrease in the number of glandular cells expressing cyclin Cdk-D1 and a 64.2% decrease in the expression of the Ki-67 protein was noted.

Conclusions. The study showed that there are objective grounds for the use of gonadotropin-releasing hormone analogues in women with endometrial hyperplasia without atypia, in whom progestogen therapy was insufficiently effective, as well as as a first-line therapy in women with low expression of PGR in glandular cells at the stage of primary histological screening.

Modern gynecology. A multi-vector approach to diagnostics and treatment

Editor Editor — Fri, 30 May 2025 00:00:00 +0300

Vitamin D is a fat-soluble vitamin that plays an important role in maintaining health. The female body is especially sensitive to its level due to hormonal changes throughout life - during menstruation, pregnancy, breastfeeding and menopause. The main functions of vitamin D are supporting the skeletal system (helps with the absorption of calcium and phosphorus, prevents osteoporosis), regulating immunity (reduces the risk of autoimmune diseases), hormonal balance (participates in the regulation of estrogen), reproductive health (contributes to normal ovarian function), mood and psycho-emotional state (low levels of vitamin D are associated with depression and chronic fatigue). Its deficiency is often unnoticed, but can cause serious disorders and diseases, so regular monitoring of vitamin D levels and, if necessary, its correction is an important part of the prevention of female reproductive pathology.

COCs are one of the most effective methods of hormonal contraception used to prevent unwanted pregnancy, and also have a number of additional health benefits. The mechanism of action of COCs is ovulation suppression; they also change the cervical mucus, which prevents the penetration of sperm, and affect the endometrium, making it difficult for the egg cell implantation. The advantages of COCs include high effectiveness in preventing pregnancy (the Pearl index reaches 0.05–0.3); regulation of the menstrual cycle; reduction of pain and bleeding during menstruation; reduction of the risk of ovarian and endometrial cancer, ovarian cysts, acne, endometriosis; the ability to control symptoms of premenstrual syndrome and hormonal imbalance.

Today, doctors have a wide selection of modern vitamin D and COC preparations in arsenal. An important factor in their choice for many women is financial availability. That's why Ukrainian drugs become a reliable alternative to imported analogues without compromising on quality, as they combine high quality, confirmed by clinical studies; modern formulas that meet international recommendations, and an affordable price, which makes their choice more possible for a wide range of patients.

The assessment of anti-recurrence efficacy of Prodexin in the treatment of bacterial vaginosis

D.G. Konkov, V.O. Rud, A.V. Starovier, O.A. Muntyan — Fri, 30 May 2025 00:00:00 +0300

Background. Bacterial vaginosis (BV) remains the most common vaginal infection globally, often exhibiting high recurrence rates despite standard antimicrobial therapy. The persistence of BV is frequently attributed to polymicrobial biofilms and altered vaginal microbiota, which challenge conventional treatment efficacy.

Objective of the study: To assess the long-term anti-relapse effectiveness and patient adherence associated with Prodexyn (a combination of octenidine dihydrochloride and dexpanthenol) compared to standard topical antimicrobial agents in women with a history of recurrent BV.

Materials and methods. In this prospective comparative study (phase II of the PRO-BAVAG project), 119 women with a previous history of BV recurrence were enrolled and stratified based on previous treatment regimens. Participants received either Prodexyn (n = 52), ternidazole (n = 41), or metronidazole (n = 26). Recurrence was evaluated using clinical symptoms and Hay-Ison criteria at 3, 6, and 9 months. Treatment adherence was measured using the MMAS-8 scale.

Results. No recurrences were recorded in the Prodexyn group after 3 months. At 6 and 9 months, the recurrence rate remained significantly lower in the Prodexyn group compared to both comparison groups (p < 0.05). Additionally, high adherence to therapy was noted in 92.3% of Prodexyn users, significantly outperforming adherence in the metronidazole and ternidazole groups (p < 0.01). The probable reason for the better anti-relapse effect of Prodexin can be considered the biofilm-targeting effect of octenidine and its lactoflora preserving effect.

Conclusions. Prodexyn demonstrated superior long-term efficacy in preventing BV recurrence and showed high patient adherence. Its dual action (targeting vaginal biofilms and preserving lactoflora) suggests a promising alternative to traditional antimicrobial therapies. Further studies are needed to confirm its biofilm-disruptive mechanisms and define optimal treatment durations.

The impact of war-related somatic traumas on women’s reproductive health and psychological status

Fri, 30 May 2025 00:00:00 +0300

Background. Somatic trauma can have a significant impact on women’s reproductive health due to impaired neuroendocrine regulation and the development of psycho-emotional stress. The war in Ukraine in recent years has led to an increase in injuries among the civilian population, including women of reproductive age, but the impact of somatic trauma in war on reproductive function remains poorly understood. Women with concomitant endocrine and gynecological pathologies, who may be more vulnerable to stress, require special attention.

Objective of the study: to evaluate the impact of different types of somatic traumas sustained during the war on the reproductive health and psycho-emotional state of women.

Materials and methods. The cross-sectional study included 64 women aged 18–45 years (mean age 31.4 ± 6.7 years) who sustained injuries as a result of hostilities in 2022–2024. Research sample was formed on the basis of the First Territorial Medical Association of Lviv. The inclusion criteria were documented injuries as a result of hostilities, the absence of cancer or severe somatic diseases before the injury. Data were collected through clinical interviews, medical records analysis, and HADS scores. Full feedback was provided by 56 women.

Results. The most common injuries among the women studied were gunshot / explosion injuries, traumatic brain injuries and limb injuries. Amenorrhea (57.1%) was the most common reproductive disorder, while the strongest associations were found between gunshot / explosive injuries and decreased libido and dyspareunia, and between traumatic brain injuries and decreased libido. Women with these injuries also had higher levels of anxiety and depression. The concomitant polycystic ovary syndrome had a negative impact on women’s psycho-emotional status, as patients with a history of this disease demonstrated significantly higher levels of anxiety.

Conclusions. Somatic traumas sustained in war significantly impair women’s reproductive health, with the nature and severity of gynecological complaints depending on the type of trauma sustained. Disorganization of the psycho-emotional state of women against the background of trauma leads to increased levels of anxiety and depression, especially among women with concomitant polycystic ovary syndrome, which should be taken into account in the multidisciplinary management of these patients.

Order of the Ministry of Health of Ukraine No. 195 «On approval of the standard of medical care ‘Breast Cancer’» dated 03.02.2025

Editor Editor — Fri, 30 May 2025 00:00:00 +0300

ЗАГАЛЬНА ЧАСТИНА
Діагноз: Рак молочної залози
Коди стану або захворювання. НК 025:2021 «Класифікатор хвороб та споріднених проблем охорони здоров’я»:
C50 Злоякісне новоутворення молочної залози
D05 Карцинома in situ молочної залози

The impact of war-related stress on the autonomic nervous system of pregnant women: risk assessment and correction strategies

M.Y. Malachynska, N.S. Veresniuk — Fri, 30 May 2025 00:00:00 +0300

Background. The autonomic nervous system (ANS) plays a crucial role in maintaining homeostasis during pregnancy, regulating maternal and fetal physiological processes. War-related stress and forced displacement significantly increase stress levels in pregnant women, potentially leading to ANS dysfunction and negatively impacting pregnancy outcomes.

Objective of the study: to assess the impact of war-related stress on ANS function in pregnant women who experienced forced relocation and compare their autonomic parameters with those of women who did not change residence. The study included 1000 pregnant women divided into three groups: the first - women who relocated from active combat zones, the second - women who moved from other regions of Ukraine, the third - a control group of Lviv residents.

Results. Women in the first group exhibited the most pronounced ANS dysfunction, with symptoms of sympathetic hyperactivity (elevated blood pressure, tachycardia, dry skin) and parasympathetic dysfunction (obesity, hypotension, bradycardia). The second group also demonstrated ANS disturbances, although less extent, whereas the control group had the lowest incidence of autonomic disorders.

The state of the ANS was determined using an adapted questionnaire by A.M. Wayne. The following studies were performed to assess vegetative parameters: measurement of systolic and diastolic blood pressure, heart rate, Kerdo vegetative index, and minute blood volume.

Conclusions. Obtained data underscore the need to develop and implement comprehensive medical and psychological support programs for pregnant women affected by forced displacement. The study suggests correction strategies, including psychological counseling, relaxation techniques, and physical activity, to mitigate the adverse effects of stress on ANS function and reduce the risk of perinatal complications.

Features of gestational dominance in pregnant and recently pregnant women in conditions full-scale war in Ukraine: results of a population-based study

Fri, 30 May 2025 00:00:00 +0300

Introduction. The problem of the demographic crisis in Ukraine in the conditions of the ongoing full-scale war has become critical both due to negative fertility and due to the prolonged impact of stress. In these conditions, the concept of gestational dominant, which depends on the environment and reflects the psycho-emotional state of the pregnant woman, acquires special importance.
Objective of the study: to investigate the features of the psycho-emotional state of pregnant women and women who have recently given birth, who have been affected by the full-scale war in Ukraine.
Materials and methods. The study was conducted on the basis of the Maternity Hospital No. 5 in Odessa and included 828 women; 63.8% of them were pregnant and 36.2% were women who had recently given birth. The participants were surveyed using google forms, which was created based on the assessment of the psychological component of gestational dominant according to I.V. Dobryakov and on the assessment of the anxiety degree according to the Beck’s Depression Inventory scale.
Results. The attitude of women towards their pregnancy was characterized by the optimal type of psychological component of gestational dominant only in 46.75 ± 8.36% of them, euphoric – in 26.12 ± 20.18%; anxious – in 18.6 ± 8.25%, depressive – in 1.82 ± 1.38% and ignoring – in 6.89 ± 2.51% of women. The attitude of pregnant women towards their child was optimal in 43.96 ± 5.47%, showed some euphoria in 31.73 ± 12.7%, anxious in 17.5 ± 15.08%; depressive in 2.06 ± 0.77 women.
The perception of the attitude of others towards their pregnancy showed that 47.5 ± 23.8% of women consider it optimal, 29.58 ± 18.29% were in a euphoric state, 5.43 ± 4.87% were in an anxious state, 1.8 ± 1.53% were depressed; and the ignoring type was leading – 15.43 ± 5.62% of the participants. Assessment of the women’s state according to the Beck’s Depression Inventory scale showed the mild depression in 25% of women; moderate depression in 9% and severe depression in 8% participants. Only 58% of women had a normal psychosomatic state.
Conclusions. Gestational dominant in war conditions is characterized by a decrease in the number of women with the optimal type and the prevalence of women with the euphoric type, which can be considered as a means of psychological protection from danger. The mental health of women is of particular importance for the future of the country. The involvement of perinatal psychologists in working with this cohort of these patients is critical.

Women’s health. Modern perinatal strategies

O.V. Kravchenko, S.M. Yasnikovska — Fri, 30 May 2025 00:00:00 +0300

On March 21–22, 2025, the All-Ukrainian Scientific and Practical Conference dedicated to the 30th anniversary of the founding of the Department of Obstetrics, Gynecology and Perinatology of the Bukovinian State Medical University was held in Chernivtsi. The department was one of the first in Ukraine to develop the perinatal scientific direction, which is still extremely relevant today.
The conference considered interdisciplinary issues of preserving women’s reproductive health, innovative approaches to solving urgent issues of obstetrics and gynecology; modern aspects of obstetric and gynecological care; discussion issues of current perinatology. The event was attended by over 60 leading scientists from higher educational institutions of Kyiv, Odessa, Dnipro, Vinnytsia, Ivano-Frankivsk, Ternopil, Lviv, Kharkiv, Poltava, Chernivtsi and the State Institution «All-Ukrainian Center for Motherhood and Childhood of the National Academy of Medical Sciences of Ukraine». Over 2,000 listeners were involved in the conference in real time.
The speakers paid special attention to modern perinatal strategies, covered in detail the risk factors for antenatal and intranatal fetal damage, the causes of delayed motherhood, the state of somatic and reproductive health in women aged 35+, and considered the consequences of late pregnancy and childbirth. The conference materials presented the features of the psycho-emotional state of pregnant displaced women, the problems of stress as a factor in changes in the health of women of fertile age during the war.
Innovative approaches to labor induction in modern obstetrics are considered, ways to reduce the rate of cesarean section based on the results of the Robson scale, pathogenesis, prediction tools for abnormal invasion and placenta previa. The main provisions of the clinical guideline “Nausea and vomiting during pregnancy. Excessive vomiting in pregnant women” are announced. Obstetric errors and errors in obstetrics are analyzed. The problems of treating the main gynecological pathology are presented at the modern level: endometrial hyperplasia, laparoscopic correction of symptomatic isthmocele, antiandrogen therapy in restoring ovulatory function in patients with polycystic ovary syndrome, etc. Some of the reports were devoted to the current issues of restoring the vaginal microbiota, controversial issues of diagnosis and therapy of vaginal dysbiosis, and a new view on the prevention and treatment of inflammatory processes of the vagina.