Search

Currently, endometriosis is one of the most common and relevant gynecological conditions. It is characterized by a wide range of symptoms, with highly heterogeneous pain being one of the most typical. The unifying concept of the algological patterns of endometriosis is chronic pelvic pain, which contributes to a pronounced decrease in patients' quality of life. Therefore, it is necessary to analyze the key pathogenetic mechanisms of pelvic pain associated with endometriosis and to determine a personalized therapeutic approach based on them.

Endometriosis remains one of the most topical diseases in current gynecology and is a multifactorial condition with an overgrowth of tissue morphologically and functionally similar to the endometrium outside the uterine cavity. One of the most frequently diagnosed forms of endometriosis is endometrioid ovarian cysts. An important feature of the clinical course of ovarian endometriosis is its negative impact on reproductive function and the recurrent nature of the disease, which may require repeated surgeries with even greater damage to the ovarian tissue. Therefore, the development of a long-term drug treatment strategy for patients with a history of endometrioid cysts aimed at preventing recurrences is urgently needed. According to domestic and foreign clinical guidelines, progestagen hormone therapy is recommended as first-line therapy for such patients. One of the most clinically studied drugs with a favorable efficacy and safety profile proven in numerous studies is dienogest. The paper presents the experience of foreign and domestic authors in conservative therapy in patients with a history of endometrioid cysts using dienogest in terms of recurrence prophylaxis.

Aim. To study the effect of combined oral contraceptives (COC) with estrogen identical to natural estrogen on the metabolic profile and body composition in females during the menopausal transition. Materials and methods. Females in the menopausal transition who needed contraception were divided into two groups. Group 1 (19 patients) received COCs containing estradiol valerate/dienogest (E2V/DNG) with a dynamic dosing regimen; Group 2 (19 patients) received monophasic COCs containing 17-estradiol/nomegestrol acetate (E2/NOMAC) for 6 months. Blood pressure (BP), parameters of carbohydrate and lipid metabolism, leptin, adiponectin, C-reactive protein, uric acid, and body composition by dual-energy X-ray absorptiometry were assessed initially and after the 6 months of therapy. Results. No significant changes in weight and body composition after 6 months of COC use were found in both groups. COCs with E2V/DNG had no significant effect on BP and all assessed metabolic parameters. Females taking COCs with E2/NOMAC showed increased fasting glucose of 4.85 (0.43) and 5.30 (0.37) mmol/L (p=0.002), insulin of 4.97 (2.35) and 8.82 (4.67) U/mL (p=0.012), NOMA index of 1.06 (0.54) and 1.88 (0.75); p=0.010 compared to baseline. However, the parameters remained within the reference values. Conclusion. COCs containing estrogens identical to natural estrogens do not affect body composition and have no significant adverse effect on BP and metabolic parameters in females during the menopausal transition, indicating that the use of these agents is acceptable from the perspective of their metabolic effects in this group of patients.

Background. After an episode of abnormal uterine bleeding, it is of critical importance to restore endometrial receptivity to prevent the recurrence of abnormal uterine bleeding and implement reproductive plans. Aim. To study endometrial steroid receptor expression in women of reproductive age after an episode of abnormal uterine bleeding due to ovulatory dysfunction during micronized progesterone or combined oral contraceptive therapy with bioidentical estrogen and dienogest. Materials and methods. A cohort prospective study was conducted. The study included 70 females aged 1840 years who were observed with abnormal uterine bleeding due to ovulatory dysfunction at the Department of Obstetrics and Gynecology of Ural State Medical University based at the Yekaterinburg Municipal Hospital №40 from 2016 to 2018. After a bleeding episode, the patients received a combined oral contraceptive with bioidentical estrogen and dienogest or micronized progesterone. Results. During therapy, variable changes in the expression of estrogen and progesterone receptors in the stromal and glandular components of the endometrium during the 6-month follow-up were observed. Discussion. Changes in steroid receptor expression and endometrial receptivity during hormone therapy are similar, although certain trends are identified which can guide the choice of hormone therapy. Conclusion. Due to the lack of complete recovery of steroid receptor expression and endometrial receptivity, even 6 months after hormonal treatment, short courses of hormonal rehabilitation after abnormal uterine bleeding due to ovulatory dysfunction are not sufficient, and permanent hormonal contraception or periodic courses of progestogens are required to prevent a relapse of the endometrial proliferation.

Endometriosis is a hormone-dependent condition occurring in women of predominantly reproductive age. It has an extremely diverse localization, clinical course and outcomes. The need for organ-sparing treatment to preserve and/or restore fertility, the negative effects of radical surgery for endometriosis on ovarian reserve and the effectiveness of assisted reproductive technologies, and the benign nature of the disease, which tends to self-limitation after menopause, lead to the search for effective methods of non-surgical treatment and the need for noninvasive diagnosis of endometriosis. The article presents the current principles of non-surgical management of patients with endometriosis.

Background. Endometriosis is a chronic progressive recurrent disease associated with pelvis pain, menses disorders and infertility. The prevalence of endometriosis (EGE) tends to increase steadily and reaches 15% among women of reproductive age. Endometriosis-associated pain can persist despite surgical and drug treatment of this disease, resulting in a significant decrease in the quality of life of patients. The main causes of EGE-associated pain are local inflammatory, adhesive, neuro- and angiogenic processes. Currently, the search for alternative methods of pathogenesis-based therapy of the disease is one of the priority tasks. Given its anti-inflammatory, enzymatic, antioxidant effects and anti-adhesion mechanism of action, bovhyaluronidase azoximer, an enzyme agent with hyaluronidase activity, is a promising drug in the complex therapy of EGE. Aim. To compare bovhyaluronidase azoxymer efficacy in complex therapy of patients with EGE using dienogest (2 mg) versus monotherapy with this progestogen in real clinical practice. Materials and methods. 149 female patients of reproductive age were enrolled in the study after surgical treatment for EGE. The patients were divided into two groups: the first group (n=94) was treated with complex therapy by dienogest (2 mg) daily within 6 months in combination with suppositories containing bovhyaluronidase azoxymer (3000 IU): 1 suppositorium once within 3 days,10 administrations; and then 1 suppositorium once in 7 days, 17 administrations, within 120 days; the second group (n=55) received monotherapy with dienogest (2 mg) daily up to 6 months. EGE-associated pelvic pain intensity, uterine bleeding severity and life quality were assessed during the study, after 30, 90, 150 and 180 days with regard to the basic values. Results. There was a statistically significant reduction of pain intensity observed in both groups compared to the basic level, using visual analogue scale of pain (VAS), the Biberoglu and Berman scale, but there was a distinct trend towards a more significant decrease in pelvic pain score basing on VAS in patients received complex therapy versus monotherapy with dienogest 2 mg after 30 days of treatment (p=0.051). Life quality assessment of patients in both groups revealed statistically significant increase in scores for all values of the SF-36 life quality scale just after the second follow-up visit. More significant life quality improvement in patients was observed with complex therapy with regard to such descriptors of the SF-36 Questionnaire as Physical functioning, Role-physical functioning, Pain intensity (p0.05). Conclusion. Bovhyaluronidase azoxymer in combination with dienogest (2 mg) improves the overall therapy effectiveness for EGE and is associated with more significant reduction in pelvic pain intensity, inflammatory and adhesive processes in the pelvis, and significant life quality improvement compared to monotherapy with 2 mg dienogest.

Aim. To assess the efficacy and safety of 24-week therapy with dienogest in patients with endometriosis-associated pelvic pain resistant to surgical treatment. Materials and methods. The study included 126 patients aged 3340 years with external genital endometriosis (EGE) confirmed by laparoscopy and morphological examination (International classification of diseases, 10th revision [ICD-10] N80.1, 80.2, 80.3, 80.4) and with pelvic pain that occurred in 36 months after surgical treatment of EGE (ICD-10 N94.8 "Pain and other conditions associated with female genital organs and menstrual cycle"). The participants were stratified into 3 groups by pain syndrome severity according to the Verbal Analog Scale (VAS). The group-1 included patients with 1040 mm, the group-2 with 4170 mm, and the group-3 with more than 71 mm pain score according to VAS. Patients of all 3 groups were prescribed the denogest (Zafrilla, Gedeon Richter, 2 mg/day) for 24 weeks (according to the current pack insert). Follow-up and assessment of treatment outcomes were carried out over 6 months. Study design: prospective, observational, comparative study. Results. In 3 and 6 months after the start of therapy, there was a stable statistically significant decrease in pain syndrome severity by all scales (Biberoglu Behrman Scale, Numeral Rating Scale, VAS) in each of the groups (p0.01). In all 3 groups, treatment led to an improvement in sexual function, assessed with the Female Sexual Function Index scale, in 3 and 6 months after the start of therapy (p0.01). According to the quality of life in endometriosis (Endometriosis Health Profile) questionnaire, the analyzed indicators significantly improved in all study participants (p0.01). Conclusion. Dienogest is an effective and safe method for the treatment of endometriosis-associated pelvic pain resistant to surgical treatment. Treatment with dienogest for 24 weeks effectively relieves pain, improves symptoms, and improves quality of life and sexual functioning.

The review presents the psychosocial characteristics of young women in todays millennial generation and survey data regarding their hormonal contraceptive requirements. The results of randomized clinical trials and real-life studies of the use of the combined oral contraceptive (COC) Qlaira containing estradiol valerate and dienogest (E2V/DNG) in a dynamic dosing regimen were analyzed, in which the reliability of the contraceptive effect of the drug was identified and confirmed, the restoration of fertility was population level after drug withdrawal, its minimal effect on metabolism and a reduced risk of cardiovascular complications (venous and arterial thrombosis) when using Qlaira COC in comparison with other COCs. The absence of a negative effect of COC E2V/DNG on body weight, sexual function and vaginal microbiocenosis in most women has been proven. The data on satisfactory characteristics of menstrual bleeding (lighter and shorter) in users of Qlaira COC and a decrease in symptoms associated with a hormone-free interval, which often occur when taking other COCs in the 21/7 regimen, are presented. The favorable efficacy and safety profile of COC E2V/DNG in real conditions, the advantages of estrogen bioidentical to the endogenous, in the composition of the drug, the dosage regimen 26/2, the positive effect on the lifestyle, determine the significant satisfaction of young women, including young women with children, and the ability to use the drug for a long time until menopause.

Aim. To investigate the modern condition of the problem of adenomyosis and its impact on womens reproductive function. Material and methods. The article presents a systematic literature review on the results of research search in electronic databases MEDLINE, PubMed, EMBASE, Cochrane Library and Elibrary. Results. Adenomyosis is a common but insufficiently studied disease. Modern imaging methods, such as transvaginal ultrasound and MRI, make it possible to diagnose adenomyosis at the early stages of the disease and perform the organ-preserving surgery. A medical treatment of adenomyosis requires to develop a lifelong management plan, the choice depends on the womans age, reproductive status and clinical symptoms. Currently, there is evidence of a negative impact of adenomyosis on fertility and pregnancy outcomes. Dienogest, a 19-norsteroid derivative, is a progestin with high selectivity to progesterone receptors, it exerts a hypogonadotropic effect and an antiproliferative effect on the endometrium. A mild regime of supression of ovarian function provides adequate conditions for blood supply to the uterus before planning a pregnancy. The immunomodulating effect of progestin may be useful for implantation and fetal protection to pregnancies occurring after treatment. Dienogest treatment increases the effectiveness of IVF cycles for adenomyosis of varying severity. Conclusion. The review summarizes the aspects of prevalence, comorbidity, risk factors, classification, mechanism of pathogenesis, clinical manifestations, diagnosis, treatment of adenomyosis, impact on fertility and pregnancy outcomes.

Aim. Comparative evaluation of the effectiveness of various types of hormone therapy for the prevention of relapses of endometrioid cysts (EC), based on clinical observation and data analysis. Materials and methods. Retrospective analysis of 122 patients (the average age 31.76.12 years) with laparoscopically confirmed endometriosis. Patients were divided into groups, according to the treatment options aGnRH (n=11), COCs (n=13), dienogest (Visanne) (n=56). A comparison group included 42 patients who did not receive hormone therapy. There were evaluated the number of reccurence in the group without therapy and in groups with different options for hormonal therapy. Results. Among patients treated with hormone therapy, the recurrence rate of EC was 3.75%, among those who have not received therapy 38.1%. Of these, 31.1% of patients had recurrence rate of EC during the first year, 37.8% during 3 years, and 31.1% after 3 years. After suppressive therapy was discontinued, the relapse rate in the aGnRH group was 63.6%, COC 50%, dienogest 24%. Conclusions. In addition to evaluating the ovarian reserve before and after surgical treatment, management tactics for patients with EC should include the long-term administration of dienogest as an anti-relapse therapy.

Adenomyosis have an extremely negative impact on a woman's reproductive health. In the absence of drug therapy, the likelihood of surgical treatment increases which could be very traumatic for the patient and lead to a decline in infertility and onset of early menopause. That is why it is extremely important to start therapy in a timely manner, the most important method of which is hormonal treatment. The article discusses the efficacy and safety profiles of progestin dienogest.

Introduction. The chronic, progressive, recurrent nature of the endometriosis results new avenues of targeted therapy for genital endometriosis with high therapeutic efficacy and minimal side effects must be explored. Nowadays, the standard of prolonged specific therapy for endometriosis is the dienogest 2 mg daily, which has already been proven to be effective in vitro, in vivo and in clinical practice. Purpose: to evaluate the effectiveness of new types of targeted pathogenetic therapy for endometriosis on the model of endometriosis in rats compared to dienogest and without treatment. Materials and methods. Endometriosis was induced on 69 Wistar rats by autotransplantation of uterine fragments onto the inner surface of the abdominal wall. After 14 days, the heterotopies had been measured by laparoscopy and then rats were randomized of into one of 6 experimental groups (dienogest, letrozole, cabergoline, metformin, vitamin D, melatonin) or a control group. All drugs were administered daily orally for three weeks, after which an autopsy and re-measuring of the size of endometrial implants were performed. Results. The most pronounced decrease in the size of endometrial implants was observed in the group of animals treated with dienogest (complete resorption - 48%, regression - 48%, without dynamics - 4%) and letrozole (complete resorption - 44%, regression - 56%) without the statistically significant difference between groups. In other groups, a significant decrease in the size of endometrial implants was demonstrated compared with the control, without a statistically significant difference between the groups. Findings. The presented study confirms the absence at the present time of oral drugs for the treatment of endometriosis, comparable in efficacy and safety with dienogest. Further research are needed to evaluate the different combinations of dopamine agonists, biguanides, vitamin D, melatonin as the supplement to the classic hormone-modulating therapy for endometriosis or as monotherapy in patients with contraindications to standard hormone therapy.

This publication is devoted to the most common problem in women of reproductive age - dysmenorrhea. Unfortunately, the underestimation of the importance of dysmenorrhea often occurs on the part of both patients and doctors. Meanwhile, dysmenorrhea causes not only a decrease in the quality of life, but also a number of serious disorders, including the risk of developing endometriosis, adenomyosis and even tumorous diseases. With such articles as prevention and prevention of diseases.

Hormonal contraception is a highly effective means of protecting against unwanted pregnancy and has been widely used throughout the world for more than 50 years. Unfortunately, in Russia, women still do not often use hormonal contraceptives as residents of Europe, North and South America. One of the reasons for the lack of proper distribution of hormonal contraceptives in our country remains insufficient awareness of the useful properties of contraception, along with an exaggerated view of the negative consequences of taking hormones, as well as a lack of time for the medical worker to provide adequate counseling. To overcome this problem, it is necessary to create easy-to-use algorithms of the practitioner's actions that help to simplify and optimize the choice of hormonal contraceptive for each specific woman depending on her health status, reproductive status and age. This publication contains an example of such an algorithm, including options for prescribing oral contraceptive drugs for different groups of women.

The article presents the latest data on the risks of complications development on the background of the use of combined oral contraceptives, as well as the treatment effects of the use of hormonal contraceptives.

The purpose of research was a comparison of the effect of a three-phase combined oral contraceptive (COC) containing estradiol valerate and dienogest in dynamic mode and single agent containing dienogest, to reduce menstrual blood loss on the background of adenomyosis.Materials and methods. Women aged 18-50 years, with a diagnosis of adenomyosis and pain hospitalized for abnormal uterine bleeding. Hysteroscopy and curettage of the uterus were performed on all the patientsw. After discharge, and the results of histological examination, patients of group 1 (no need of hormonal contraception), dienogest monotherapy was administered at a dose of 2 mg per day continuously for 6 months. Group 2 patients (who needed effective contraception) were administered three-phase COCs containing estradiol valerate and dienogest (2 days 3 mg estradiol valerate, 5 days estradiol valerate 2 mg/2 mg dienogest, 17 days estradiol valerate 2 mg/3 mg dienogest, 2 day 1 mg estradiol valerate and 2 days of placebo); 3 groip patients (not need for contraception) were treated with antifibrinolytic drug tranexamic acid at a dose of 1000 mg per day orally. Evaluates the performance of blood coagulation.Conclusions. Against the background of monotherapy a significant and reliable reduction of menstrual blood loss and the severity of pain was shown that demonstrates its effectiveness in the treatment of abnormal uterine bleeding associated with adenomyosis.

In this paper we investigate the effect of dienogest on endometrial morphology and function in patients with external genital endometriosis. It is shown that dienogest is effective in reducing pain in patients with external genital endometriosis and endometrial morphology and function improves, suppresses manifestations of inflammation in the lining of the uterus.

This article is a review of continuous use of oral contraception.

This article presents the results of studies 58 patients, mean age 29±1,7 years with chronic pelvic pain and laparoscopically confirmed diagnosis of external genital endometriosis. Based on the research results of estrogen metabolites has been allocated two groups studied patients. Group I – 26 patients (44,8%) with a predominance of carcinogenic fractions of estrogen in the urine of 2-ONE1/16-ONE1 least 2 (average 0,8±0,2), II group – 54 patients (55,2%) with normal estrоgen metabolism (average 2,3±0,3). Against the background of suppressive therapy with dienogest 2 mg after surgery in 12 months was significant (p