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An issue of endometrial hyperplastic processes in the reproductive period is one of the pressing problems of gynecology due to their high prevalence in this age group. The continuing interest in this issue is determined by the data that endometrial hyperplastic processes tend to have a long, relapsing course, the lack of specific, pathognomonic symptoms as well as the complexity in differential diagnosis and choice of methods for prevention and treatment. Unfortunately, the problem of treating such patients remains far from being solved, which dictates a need to optimize patient management tactics, which should be aimed not only at creating proper integrated approaches to predicting development and recurrence of endometrial hyperplastic processes, but also developing a differentiated approach to management patients with this pathology in order to reduce gynecological and oncological morbidity as well as increase reproductive potential in this patient cohort.

Research objectives: to evaluate the effect of vitamin D supplementation (Olidetrim) in the complex anti-relapse therapy of bacterial vaginosis (BV) in women of reproductive age. Materials and methods. The study included 63 women of reproductive age with BV and with a level of 25-hydroxyvitamin D below 75 nmol/l, who were divided into groups: the main group included 32 women who were prescribed standard therapy (metronidazole 500 mg twice a day for 7 days) and cholecalciferol (Olidetrim) 4000 IU/day with subsequent continuation of its intake in a dose 2000 IU/day for up to 6 months; the comparison group included 31 women, who were not intake vitamin D preparation during the standard therapy and during the next 6 months of observation. After treatment, women provided completed questionnaires and self-collected vaginal swabs 1, 3, and 6 months after beginning of the study or before BV relapse. Evaluation of Gram-stained smears was carried out by microscopy according to Hay/Ison criteria, where BV corresponded to type III. The level of 25-hydroxyvitamin D in blood serum was determined by the chemiluminescent immunoassay method before the start of the study and at 3 and 6 months of follow-up. The primary endpoint was BV recurrence at any post-treatment interval; the patients were offered a second treatment in this case. Results. Vitamin D deficiency at the beginning of the study was detected in 12 (37.5%) patients of the main group and in 13 (41.94%) women of the comparison group, an insufficient level – in 20 (62.5%) patients of the main group and in 58.06% women of the comparison group. Patients complained of pathological vaginal discharge, itching, burning and dyspareunia lasting from 1 week to 2 months. At the seven-day course of basic BV therapy all participants noted the normalization of discharge and the absence of vaginal discomfort. Positive dynamics were also observed according to the gynecological examination. One month after the treatment, 4 (12.5%) participants of the main and 6 (19.36%) women of the comparison group noted the recovery of symptoms. Absence of BV recurrence after 3 months was noted by 25 (78.12%) women of the main group and 16 (51.61%) women of the comparison group (p = 0.054), that was confirmed by the laboratory tests. At the same time, the level of 25-hydroxyvitamin D in the main group increased by 43.37% (p = 0.05), and in the comparison group it did not differ from the initial level. There were no complaints in 24 (75.0%) patients after 6 months, however, a laboratory-confirmed normal state of the vaginal microbiome was observed in 22 (70.96%) participants of the main group and in 14 (45.16%, p = 0.07) women of the comparison group. Continuation of vitamin D intake at a dose of 2000 IU/day for the next 3 months demonstrated maintenance of the 25-hydroxyvitamin D level within normal values (81.7 ± 6.23 nmol/l in the main group vs. 38.51 ± 5.43 nmol/l in comparison group, p = 0.05). Conclusions. A decrease in the frequency of BV recurrences in women during support a normal level of vitamin D was found, which allows recommending the inclusion of cholecalciferol supplementation (Olidetrim) in the standard treatment. In patients with recurrent BV a long-term monitoring of the serum level of vitamin D is advisable in order to timely prescribe supplementation.

Research objective: to increase the effectiveness of bacterial vaginosis (BV) treatment in women of reproductive age. Materials and methods. The study involved 64 women of reproductive age with BV. After a course of local antibiotic therapy participants were divided into 2 groups: patients of group I were not prescribed local remedies to restore the vaginal microflora, patients of group II were prescribed vaginal prebiotic suppositories Folial № 10. No additional drugs were used in subgroups IA and IIA, while oral probiotic Maxibalance was prescribed in subgroups IB and IIB. The effectiveness of BV treatment was evaluated at the first, third and sixth months of the observation period according to the results of clinical examination and vaginal pH evaluation by litmus strips. Results. The course of BV in subgroup IA was characterized by prevailing number of relapses and their early appearance. 1 case of BV recurrence was found among patients of subgroup IA at the 1st month of follow-up, 6 and 8 BV episodes were found at 3 and 6 months of follow-up respectively. Sequential treatment with antibiotics and oral probiotics (subgroup IIB) was associated with the onset of 3 BV relapses on 4–5 months from baseline. Local prebiotic (subgroup IIA) after the vaginal sanation was associated with BV reoccurrence in only one patient at the end of the study. No relapses of BV were detected in subgroup IIB during the study. Conclusions. Permanent imbalance of vaginal normocenosis creates optimal conditions for chronic and recurrent diseases of dysbiosis nature, especially BV. Despite the sensitivity of the anaerobic flora to the recommended antibacterial medications, their use as monotherapy in BV treatment is often insufficient. The results of the study demonstrate a significant anti-relapse efficiency of consecutive treatment by antibacterial drugs and a complex of probiotic + prebiotic. This effect is probably based on the restoration of vaginal immunity and metabolism by stable colonization of the vaginal mucosa with live lactobacilli of eubiotic origin.

Research aim: to determine the clinical efficacy and safety of bioavailable curcumin Longimin® in the complex anti-relapse therapy of patients with extragenital endometriosis after surgery. Materials and methods. Study involved 45 women with a mean age of 29.3 ± 3.6 years with a diagnosis of extragenital endometriosis. After surgical treatment of this disease all patients were prescribed dienogest 2 mg/day for 6 months with anti-relapse purpose. After that, 22 patients did not receive drug treatment (group 1) and other 23 women started a six-month course of 400 mg bioavailable curcumin (group 2). Results. After 12 months of observation 3 cases (13.6%) of newly formed foci of endometriosis were found among patients of group 1, two of which were multi-endometriomas, and the third was retrocervical heterotopia. There were no signs of recurrence in the group of sequential use of dienogest and bioavailable curcumin. In addition, 6 months after completion of hormonal treatment the number of women with chronic pelvic pain in group 1 was increased and average score on a visual analogue scale (VAS) was increased by 80% (p ≤0.05). It was accompanied by a stable moderately high level of anxiety throughout the observation period. At the same time the number of women who complained of intermenstrual pain in group 2 decreased from 15 to 13, and the average VAS score decreased by 13% (p ≥0.05) during the treatment period. Patients in group 2 noted an improvement in emotional control during treatment, which resulted in the average score decrease on the scale of personal and situational anxiety of the Spielberg-Hanin's questionnaire (25% and 30% respectively, p ≤0.05). Conclusions. The nature of the endometriosis development and progression is multipathogenetic. Blocking only its hormonal link, especially in cases of extragenital forms, may not be sufficient to stop the pathological process and prevent recurrence in the long term. Оbtained results of sequential course of dienogest and bioavailable curcumin Longimin® with anti-relapse purpose showed the wider clinical effectiveness of this therapy, which is probably based on additional inhibition of systemic inflammation, proliferation, stroma and psychogenic component of disease.