REPRODUCTIVE ENDOCRINOLOGY

Thyroid autoimmunity and assisted reproductive technologies: modern controversies

Fri, 20 Jun 2025 00:00:00 +0300

Background. Thyroid autoimmunity (TAI) affects approximately 13–19% of those experiencing infertility and is often associated with unexplained infertility, recurrent miscarriage, polycystic ovary syndrome, lower antral follicular count, reduced ovarian reserve and embryo quality.

Objective of the review: to consolidate and interpret recent studies investigating the role of TAI in ART success.

Materials and methods. Following several key principles of the PRISMA guidelines the following databases were searched for the last 5 years: MEDLINE (PubMed), Embase, Scopus, Lilacs, Web of Science, Clinical Trials, and SciELO.

Analysis of literary data. While some evidence links TAI with impaired reproductive outcomes, such as reduced fertilization and implantation rates and increased miscarriage, other studies propose that intracytoplasmic sperm injection may alleviate these issues by avoiding immune interference during fertilization. TAI-positive women tend to develop hypothyroidism during ovarian stimulation with human chorionic gonadotropin trigger, which may further compromise pregnancy outcomes. Data supporting the same risk under alternative stimulation protocols are currently not well established. Lastly, transitional hyperthyroidism in cases of postpartum thyroiditis, presents an added challenge for women initiating ART soon after miscarriage.

Conclusions. Early identification of TAI in women undergoing ART is crucial. Screening programs and personalized treatment strategies play a key role in improving fertility outcomes.

Existing data highlights potential areas for further study. These involve the influence of postpartum thyroiditis on ART results, as well as the role of alternative ovulation triggers in TAI-positive patients in order to get better obstetric outcomes. In addition, upcoming research should concentrate on optimizing diagnostic models and developing personalized treatment plans.

Order of the Ministry of Health of Ukraine No. 535 «On approval of the standard of medical care ‘Benign diseases of the breast. Tactics of managing abnormal results of breast examination’» dated 26.03. 2025

Fri, 20 Jun 2025 00:00:00 +0300

Загальна частина
коди стану або захворювання. НК 025:2021 «Класифікатор
хвороб та споріднених проблем охорони здоров’я»:
N60. Доброякісна дисплазія молочної залози
N60.0 Солітарна кіста молочної залози
N60.1 Дифузна кістозна мастопатія
N60.2 Фіброаденоз молочної залози
N60.3 Фібросклероз молочної залози
N60.4 Ектазія проток молочної залози
N60.8 Iнші доброякісні дисплазії молочної залози

N60.9 Доброякісна дисплазія молочної залози, неуточнена
N61. Запальні хвороби молочної залози
N63. Неуточнене утворення в молочній залозі
N64. Iнші хвороби молочної залози
N64.3 Галакторея, не пов’язана з пологами
N64.4 Мастодинія
N64.5 Iнші ознаки та симптоми, що стосуються молочної
залози
N64.8 Iнші уточнені ураження молочної залози
N64.9 Ураження молочної залози, неуточнене

Features of the formation of psycho-emotional disorders and identity crisis in patients with tumors of the reproductive system after hysterectomy

V.O. Belyak, R.I. Bilobryvka, O.I. Yakubets — Fri, 20 Jun 2025 00:00:00 +0300

Objective of the study: to evaluate the psychoemotional condition in patients with benign and malignant tumors of the reproductive system after hysterectomy and successfully completed treatment.

Materials and methods. The study included 75 women aged 38 to 70 years who had undergone hysterectomy, including 53 women with malignant tumors of the female reproductive system (group 1) and 22 women with benign tumors (group 2). All patients were surveyed using the NCCN Distress Thermometer (Ukrainian version 2.2022) to determine the level of distress and identify psychoemotional disorders before and after surgical treatment.

Results. The data obtained during the study allowed to establish that although before the surgical intervention was no statistically significant difference in the level of distress between the groups of women with malignant and benign tumors, after hysterectomy in the group of patients with malignant tumors was noted a significantly higher level of emotional problems (in particular, according to the parameters of the sadness and depression, loss of interest or ability to get pleasure, loneliness and feelings of worthlessness), social problems (relationships with children, family members, friends or colleagues, communication with medical professionals), as well as practical problems. At the same time, according to indicators of physical problems, as well as a number of emotional, social and practical problems, patients with benign tumors demonstrated the same high level of distress as patients with malignant tumors.

Conclusions. The results of the study allow us to draw conclusions about the need for active screening to assess the level of distress. The presence of psychoemotional disorders and identity crises after hysterectomies was evident not only in the group of patients with malignant tumors, but also in women with benign tumors of the reproductive system. NCCN Distress Thermometer can be used for the purpose of such screening

Sex differences in peripheral vascular disease

Fri, 20 Jun 2025 00:00:00 +0300

Scientific Statement from the American Heart Association
Sex differences in the risk factors, diagnosis, treatment, and outcomes of patients with cardiovascular disease have been well described; however, the bulk of the literature has focused on heart disease in women. Data on sex differences in peripheral vascular disease are ill defined, and there is a need to report and understand those sex-related differences to mitigate adverse outcomes related to those disparities. Although peripheral vascular disease is a highly diverse group of disorders affecting the arteries, veins, and lymphatics, this scientific statement focuses on disorders affecting the peripheral arteries to include the aorta and its branch vessels.
The purpose of this scientific statement is to report the current status of sex-based differences and disparities in peripheral vascular disease and to provide research priorities to achieve health equity for women with peripheral vascular disease.

Reproductive health and sexual violence: mutual determination of phenomena

Y.S. Oliinyk, I.I. Zabokrytskyі, O.I. Hutsuliak, A.M. Halaiko — Fri, 20 Jun 2025 00:00:00 +0300

Background. The sexual violence forms a negative legal practice of violations of somatic human rights and a destructive impact on public life and human reproductive health.

Objective of the study: to conduct an intercomplementary study of sexual violence as a destructive factor affecting human reproductive health.

Materials and methods. The basis of the methodology is a comprehensive approach combining medical knowledge, concepts and principles of research, as well as social sciences and law. The epidemiological research method was used to analyze the causes of sexual violence in society and the prevalence of the problem in individual groups, regions and time dimensions. The cross-sectional method was used to analyze the consequences of sexual violence for the health of the nation by determining the attitude of society to such a problem, establishing its prevalence and the effectiveness of legal and organizational mechanisms for its resolution. The abstraction method allowed avoiding subjectivism and personal empiricism in scientific research. The author’s survey method allowed for an analysis of the social state of the outlined issues. 785 women of reproductive age participated in the author’s survey, conducted during 2022–2024 in 4 regions of Ukraine. The use of the highest level of evidence (including meta-analyses and systematic reviews) ensured the validity of the conclusions.

Results. The modern understanding of the concept of sexual violence was determined and its negative consequences for the individual and society were established; forms of sexual violence were analyzed by subjects of origin; the causes of violent acts including rape and sexual harassment were established; relevant means of combating the problem of sexual violence were identified at the current stage of development of social culture and statehood. The special role of services that prevent and counteract manifestations of domestic violence, especially health care bodies, was emphasized.

Conclusions. Analysis of reports by international organizations (UN, WHO, UNICEF) and doctrinal experiments conducted by scientists allow us to distinguish two areas of consequences according to the classification of the subject: those that affect the health of the person who suffered from violence (physical, sexual, reproductive, mental), and the economic and social mechanism of society and the state. The characteristic features of sexual violence are identified and substantiated. A grouping of types of sexual violence is carried out and it is proposed, in addition to actions committed by an intimate partner and non-partner, to single out sexual crimes committed as a means of waging war as a separate type. Proposals for improving the state mechanism for preventing and combating sexual violence are summarized.

Influence of environmental factors on disorders of compensatory-adaptive changes in pregnant women during the period of full-scale war in Ukraine

V.P. Mishchenko, V.V. Mishchenko — Fri, 20 Jun 2025 00:00:00 +0300

Background. The process of pregnancy by physiological type depends on many factors, among which the leading ones are the premorbid background against which pregnancy occurred, and the influence of epigenetic negative environmental factors of the woman’s place of residence.

Objective of the study: to study the influence of environmental factors on compensatory-adaptive changes in the body of pregnant women during the period of full-scale war.

Materials and methods. 60 pregnant women were observed. Anamnestic data were studied, anxiety and psycho-emotional state were assessed. Levels of cortisol, progesterone, magnesium, iron, vitamin D, ferritin, hemoglobin, and glucose were determined. The algorithm of therapeutic tactics of the examined women was personalized depending on the assessment of the general condition, mental health, anamnestic data, laboratory test results, etc.

Results. The somatic anamnesis of the study participants indicates a high frequency of hypothyroidism. In the vast majority of women, the highest level of anxiety was in the first trimester. From the second trimester, the condition of pregnant women stabilized against the background of the recommended personalized therapy. Pregnancy, childbirth, postpartum periods took place against the background of significant psychoemotional stress, tension, and increased somato-vegetative function. The severity of these processes depends largely on the individual characteristics of the mental and physical state of the woman. Higher levels of anxiety led to higher levels of cortisol and lower levels of progesterone, magnesium, vitamin D, hemoglobin, and ferritin. The level of glucose tended to increase by trimester of gestation.

Conclusions. Adverse environmental factors during pregnancy lead to disruption of compensatory and adaptive mechanisms and development of gestational complications. The pregnancy process reasonably requires a personalized algorithm for managing the each woman separately with the determination of the levels of cortisol, progesterone, vitamin D, magnesium, hemoglobin, iron, ferritin and correction of vitamin, macro-, microelement metabolism, progesterone content, as well as stabilization of psycho-emotional status, rational balanced nutrition, drinking regimen, prevention of hypodynamia.

Management of abnormal uterine bleeding in the current realities

Fri, 20 Jun 2025 00:00:00 +0300

Objective of the study: to optimize approaches to the treatment of abnormal uterine bleeding (AUB) in internally displaced women, considering its impact on patients’ quality of life, mental health, and daily activity.

Materials and methods. The study included 90 women aged 18–55 years diagnosed with AUB. The patients were divided into three groups of 30 people, who received different treatments for 3 months during menstruation and bloody discharge: group I took a herbal hemostatic complex (Foxygen); group II took a hemostatic complex in combination with a preparation of Vitex agnus castus extract Ze440 20 mg (Prefemin); group III (control) took a tranexamic acid 500 mg three times a day. The effectiveness of therapy was assessed using the SF-36 scale for quality of life evaluation, the SAN scale for assessing well-being, activity, and mood, as well as by measuring the duration and volume of blood loss.

Results. After three months of therapy, all groups showed a significant reduction in the duration and intensity of bleeding (p < 0.05). The best results were observed in group II, where the mean duration of bleeding decreased to 5.1 ± 0.7 days, and the menstrual blood loss volume decreased to 61.2 ± 7.4 ml. In group III, these values were 5.0 ± 0.8 days and 57.5 ± 6.1 ml, respectively. Quality of life improvements on the SF-36 scale were most pronounced in group II, particularly in general health perception, social functioning, and mental health. The SAN scale demonstrated significant improvements in well-being and mood, especially in groups II and III.

Conclusions. The combined use of herbal preparations is an effective and safe alternative to standard AUB therapies in women. This therapy not only supports hemostasis but also positively influences the patientsвЂ™ psycho-emotional state, making it a crucial component of comprehensive AUB management in stressful conditions.

The impact of post-traumatic stress disorders on women’s reproductive function

O.H. Horbatiuk, O.V. Vaskiv, L.V. Pypa, I.M. Mandziy, O.H. Ishchuk — Fri, 20 Jun 2025 00:00:00 +0300

Objective of the study: to investigate the course of secondary amenorrhea in women with posttraumatic stress disorder (PTSD) based on the study of their hormonal and immune system.

Materials and methods. The study included 54 women of reproductive age with amenorrhea and PTSD (main group). Using enzyme-linked immunosorbent assay, the levels of prolactin, follicle-stimulating and luteinizing hormones, estradiol, progesterone, free testosterone, anti-Müllerian hormone, thyroid-stimulating hormone, free thyroxine, daily urine cortisol, as well as antibodies to thyroid peroxidase (TPOAb) and ovarian autoantibodies were determined. According to the hormonal study, the women were divided into 2 subgroups: the first subgroup included 35 (64.8%) patients with functional hypothalamic amenorrhea (FHA), the second subgroup included 19 (35.2%) women with premature ovarian insufficiency (POI). The control group consisted of 23 healthy women aged 18–37 years.

Results. It was detected a 1.5-fold increase level of prolactin in the subgroup with POI vs. control group. Significantly elevated thyroid-stimulating hormone levels were found only in the POI subgroup (21.1% vs. 0% of in the control). Ovarian antibodies were detected in 26.3% of patients with POI vs. 2.9% in women with FHA (p ˂ 0.05). The increased TPOAb levels were not detected in the subgroup of women with FHA and in the control group, but in patients with POI it was detected in 21.1% of cases. А simultaneous increase in the level of both TPOAb and ovarian antibodies was diagnosed in 10.5% of patients in the subgroup with POI.

Conclusions. Disorders of reproductive function in women with PTSD can be manifested by FHA or POI. The presence of TPOAb and ovarian antibodies IgG indicates the significant role of the immune system in the choice of the pathogenetic chain of amenorrhea development.