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Intrauterine adhesions (IUDs) are one of the unresolved and unsolved problems of modern reproductive medicine worldwide. Adhesive lesions lead to partial or complete obliteration of the uterine cavity and/or cervical canal. The main clinical manifestations of IUDs are menstrual irregularities, cyclical pain, infertility and other various reproductive disorders. Reproductive outcomes in women with IUDs remain poorly understood and difficult to verify. At the same time, there is currently no understanding of the basic mechanisms of IUD development, including the processes explaining the failures of the above complications. The problem of overcoming IUD recurrences after adhesiolysis remains far from being finally resolved. The gold-standard treatment for IUD is hysteroscopic adhesiolysis, which, however, is associated with a high frequency of complications and relapses, highlighting the need for preventive approaches to the management of IUD. The drugs with enzymatic activity inhibiting abnormal connective tissue include bovhyaluronidase azoximer created by the Russian developers back in 2005. The drug consists of two components – hyaluronidase and azoximer bromide. The former is an enzyme, and the latter is a stabilizer that prolongs the action of hyaluronidase. Several studies have shown that bovhyaluronidase azoximer causes the destruction of intrauterine adhesions and restores the endometrium status in inflammatory pelvic diseases. Due to prolonged antifibrotic effect of bovhyaluronidase, azoximer can be used to treat women with IUDs to reduce the risk of the subsequent development of adhesive process in the uterine cavity.

Objective. Objective of this review is the systematic analysis and summarization the scientifc data available in the current literature on the predictive approach to the management of women with endometrial hyperplasia without atypia.Material and methods. Scientifc literature was searched in PubMed, CochraneLibrary, Science Direct, and ELibrary databases using the keywords,endometrial hyperplasia and cancer, pathogenesis, risk factors, and recurrence for 2012–2022.Framework. Endometrial hyperplasia (EH) is a common disease that affects women of reproductive age and is caused by a disturbance of the local hormonal homeostasis of the endometrium. Several factors, such as age over 35, lack of pregnancy history, obesity, genetic predisposition, diabetes mellitus, anovulatory cycles, hormone replacement therapy, including menopausal therapy (without the progestin component) and immunosuppression can lead to the development of this condition. Modern predictive medicine can be used to identify women at high risk for developing this condition and target screening and surveillance, as well as individualized treatment plans. Overall, the use of predictive in the management of endometrial hyperplasia without atypia may improve the treatment outcomes of the patients in the cohort studied.Conclusion. Combined oral contraceptives (COCs) have been proven to have not only high contraceptive effcacy, but also to be considered as a pathogenetically justifed prevention of EH without atypia and its recurrence. Gestoden-containing COCs are recognized as an effective means not only for the prevention of endometrial hyperplasia, but also for the prevention of endometrial carcinoma, while having absolutely similar effcacy to other progestins, such as levonorgestrel. Thus, OCs containing gestoden should be considered as an attractive option not only to prevent unwanted pregnancy with high contraceptive effcacy, but also to regulate the menstrual cycle, to minimize breakthrough bleeding and to prevent EH without atypia.

Endometrial polyps are the most commonly observed pathological finding in the uterus. However, to date, there is little data regarding the factors for the development of endometrial polyps in reproductive-age women. This fact determined the direction of our study. A search was conducted among scientific papers in the Science Direct, CochraneLibrary, PubMed databases by keywords (polyps, endometrium, risk factors, reproductive age) for 1994–2022. As a result of the analysis of the scientific literature, we came to the following conclusions: 1. The prevalence of endometrial polyps depends on the studied population, while the actual prevalence is difficult to determine, since the endometrial polyps can be asymptomatic and regress over time. 2. Implementation of endometrial polyps, apparently, depend not on one, but on many factors: genetic, hormonal, metabolic, medicinal. 3. Increasing the amount of endogenous estrogen, the introduction of exogenous estrogen without progesterone component and age are the most important predisposing risk factors for the development of endometrial polyps.

Childless marriages remain an important medical and social problem at present, both in our country and around the world. Infertility is a violation of the reproductive system, which has a wide range of conditions that affect one of the most important human functions – the ability to reproduce. The uterine factor of infertility occupies one of the leading positions in the formation of both primary and secondary infertility. Given the growth of acquired forms of uterine infertility, it is impossible not to turn to such a disease as intrauterine adhesions. Intrauterine synechiae is an acquired uterine disease that occurs after an injury to the endometrial mucosa. In the modern world, the prevalence of intrauterine adhesions in women of the reproductive period is increasing every year. However, it should be noted that despite modern technologies, it is impossible to accurately determine the number of women who have intrauterine adhesions. Taking into account the multifactorial development of intrauterine adhesions, as well as the low effectiveness of treatment methods, this problem occupies one of the leading positions in the structure of gynecological diseases and remains relevant. The asymptomatic course of the adhesive process leads to difficulty in diagnosis, and therefore the clinician needs to be aware of the risk factors for the development of intrauterine synechiae. The review presents risk factors for the formation of intrauterine synechiae.

To study the relationship between vitamin D deficiency, VDR gene polymorphism rs10735810 (A G), and a missed abortion in the first trimester of gestation; to determine the predictors of its risk.178 women aged between 18 and 41 were surveyed. The main group consisted of patients with miscarriage (WE found that patients with miscarriage in the first trimester of gestation (The data obtained show that vitamin D insufficiency plays a pathogenetically significant role in early reproductive losses associated with miscarriages, both first and recurrent.

Актуальность: Исследования этиологии и патогенеза неудач имплантации, как повторных, так и первичных, а также возможностей терапии на сегодняшний день несут в себе множество контраверсий. Однако многочисленные исследования последних лет продемонстрировали высокую эффективность различных методов физиотерапии в улучшении репродуктивных исходов, в том числе в терапии и преодолении повторных неудач имплантации в программах экстракорпорального оплодотворения. Цель исследования: определение возможностей физической терапии повторных неудач имплантации в программах экстракорпорального оплодотворения. Материалы и методы: Для изучения возможностей физической терапии повторных неудач имплантации в программах экстракорпорального оплодотворения был проведен отбор и анализ научных источников за 1995-2020 годы, доступных в базах Scopus и Pubmed, по ключевым словам «экстракорпоральное оплодотворение», «повторные неудачи имплантации», «вспомогательные репродуктивные технологии», «физиотерапия». Результаты: Электроимпульсная терапия зарекомендовала себя как наиболее изученный физический метод лечения нарушений рецептивности эндометрия с доказанной эффективностью. Физиотерапевтические методы воздействия позволяют улучшить репродуктивные исходы посредством благотворного влияния на ангиогенез и архитектонику эндометрия, улучшая его рецептивность, нормализуя физиологию. Заключение: Необходимо дальнейшее детальное исследование этиологии, патогенетических механизмов, а также эффективности преодоления повторных неудач имплантации различными методами для разработки полноценных протоколов лечения.

Данные последних лет указывают на то, что качество эндометрия играет гораздо более важную роль в успешной имплантации и наступлении клинической беременности, чем многие другие признанные факторы. Хронический эндометрит (ХЭ) ассоциирован с отрицательными репродуктивными исходами, которые включают повторные неудачи имплантации. Streptococcusspp., Escherichiacoli, Enterococcusfaecalis, Klebsiellapneumoniae, Staphylococcusspp., Corynebacterium и Mycoplasma / Ureaplasmaspp в настоящее время считаются основными возбудителями ХЭ. Это заболевание нарушает архитектонику эндометрия на разных уровнях: прежде всего, ХЭ способствует изменениям в популяции иммунокомпетентных клеток и, следовательно, способствует нарушению локального иммунного ответа в эндометрии в момент имплантации. Лечение ХЭ антибиотиками улучшает частоту имплантации и снижает частоту абортов, хотя хорошо спланированные проспективные исследования, подтверждающие этот вывод, отсутствуют.Учитывая недостаточную эффективность антибиотикотерапии ХЭ, особенно в случаях резистентности возбудителей, либо в случае вирусного хронического эндометрита, необходимо разработать схемы с дополнительным применением препаратов, влияющих на другие этиопатогенетические пути развития и поддержания ХЭ. Примером такого лечения может быть цитокинотерапия, требующая дальнейшего изучения в отношении эффективности и безопасности в терапии ХЭ.

There is a statistically significant difference in the frequency of implantation in the group of patients with endometriosis associated with infertility compared with the control group. This has been confirmed by a number of different studies. The aim of the study to expand the understanding of the pathogenesis of implantation failures in patients with infertility associated with endometriosis

Pelvic floor dysfunction is an important medical and social problem in the female population. The impact of pelvic floor disorders (PFD) is likely to grow as the prevalence of these disorders increases with an aging population. Pregnancy and delivery are considered major risk factors in the development of POP and stress urinary incontinence. Pelvic floor dysfunction may involve pelvic organ prolapse and/or pelvic floor relaxation. Organ prolapse can include any combination of the following: urethra (urethrocele), bladder (cystocele), or both (cystourethrocele), vaginal vault and cervix (vaginal vault prolapse), uterus (uterineprolapse), rectum (rectocele), sigmoid colon (sigmoidocele),and small bowel (enterocele).Given the paucity of understanding of PFD pathophysiology ,multicompartmental pathology, the high rate of recurrence and repeat surgery imaging plays a major role in its clinical management.The magnetic resonance imaging (MRI) allows noninvasive, radiation-free, rapid, high-resolution evaluation the multicompartment defects in one examination.Findings reported at MR imaging of the pelvic floor are valuable for selecting candidates for surgical treatment and for indicating the most appropriate surgical approach.

Since the chronic endometritis often leads to impaired reproductive function causing infertility, failed IVF attempts, miscarriage, and complicated pregnancy and childbirth, it has become not only medically relevant but also socially significant. For successful embryo implantation, the thickness of the endometrium should be at least 7 cm. Even though there is always a chance for embryo implantation, despite the endometrial hypoplasia, the attachment may be fragile, and such pregnancy may cease its development further on. Recently, in connection with an increase in the rate of developing allergic reactions, dysbacteriosis, and the emergence of drug-resistant strains of microorganisms, a search for new treatment methods to avoid these complications has begun. One of such methods in treating chronic endometritis, satisfying several requirements (efficiency, comfort, accessibility, safety), is the ultrasonic cavitation of the uterine cavity.

The article discusses features manifestations of benign dysplasia remaining contralateral breast in patients with triple negative and Her2/neopositive breast cancer (BC) after a comprehensive treatment based on the results of mammography and ultrasound evaluation.Materials and methods. A sample of 43 people was divided according to biological types of breast cancer into two groups: I (n = 17) and II (n = 26). All patients underwent mammography in two projections and an ultrasound with the calculation of the thickness glandular component and the echo density of the parenchyma.Results. In all patients with breast cancer, benign changes in the remaining contralateral mammary gland of varying severity were noted: prevalence of cystic‑fibrous form — subgroup I (n = 17); subgroup II (n = 14) prevalence of the fibrocystic component; subgroup III (n = 12) was evaluated as a mixed glandular‑fibrous form of benign dysplasia remaining contralateral breast. An excess of the normal thickness of the glandular component was found: subgroup I Mc = 34.3 ± 2.1 mm; subgroup II M = 24.4 ± 3.3 mm; subgroup III M = 28.2 ± 1.7 mm. The echo density of the parenchyma of the remaining mammary contralateral gland also exceeded the reference values in all patients: subgroup I M = 34.1 ± 2.5 cu, subgroup II M = 42.3 ± 2.3 cu, subgroup III M = 37.5 ± 1.7 cu. After phytoprevention and phytotherapy with the herbal homeopathic medicine Mastopol®, 1 tablet 3 times a day under the tongue for 12 weeks, there was a positive dynamics in the antiproliferative status of the respondents. In all subgroups, a decrease in the mammographic density of the mammary gland was found. The glandular component and the echo density of the mammary parenchyma decreased according to the results of ultrasound. In the subgroup, the pancreatic component reached М = 23.4 ± 2.3 mm; in subgroup II М = 17.5 ± 2.4 mm; in subgroup III М = 20.3 ± 1.7 mm. Echo density: in the subgroup I М = 27.3 ± 3.1 cu; in subgroup II М = 31.6 ± 1.9 cu; in subgroup III М 21.4 ± 2.3 cu.Conclusions. All breast cancer patients, regardless of the molecular subtype of the tumor, have benign changes in the contralateral mammary gland. The medicinal homeopathic complex can be considered a pathogenetically substantiated method for the prevention and treatment of DDM. The use of a herbal medicinal homeopathic remedy for the intended purpose (according to the instructions for the drug) of benign dysplasia remaining contralateral breast therapy for 12 weeks has a positive effect on the breast tissue, reducing mammorgafic density, reducing the glandular component of the mammary gland.

Methods. For morphological studies it were using fragments of walls 60 uterus, received after hysterectomy in patients with pelvic pain on a background of diffuse adenomyosis II-III degree, and 30 uterus of women with painless form of adenomyosis. Expression of vascular endothelial growth factor (VEGF) was measured in endometrial and myometrial tissues using immunohistochemistry. The results showed a significantly higher expression of VEGF in patients with adenomyosis pain phenotype compared to the same in women with silent form in the epithelial cells of ectopic endometrium (14,7 ± 1,6 vs. 10,7 ± 1,6%, p0,01) in the smooth muscle cells of the myometrium (12,6 ± 1,4 vs. 9,6 ± 1,2%, p0,01), in the stromal cells of the myometrium (10,1 ± 1,9 vs. 7,4 ± 1,8%, p0,01).

Objective: to analyze the role of inflammatory and immune reactivity in the development of adenomyosis and its associated pain. Methods. For morphological studies it were using fragments of walls of 56 uterus received after hysterectomy in patients with pelvic pain on a background of diffuse adenomyosis II-III degree, and 30 patients with painless form of adenomyosis. To identify, evaluate the amount and spatial distribution of macrophages, T-helper cells and natural killer cells it was using MAbs to CD68, CD4, CD56 respectively. The results of the study showed a significantly high expression of CD68 (49,3 ± 2,3 vs. 21,2 ± 1,7 conv. units, p0,01), CD56 (47,4 ± 2,7 vs. 17.2 ± 1.8 conv. units, p0,01, p0,05) and CD4 (52,1 ± 2,2 vs. 19,9 ± 2,5 conv. units, p0,01) in patients with painful form of adenomyosis in the regions of ectopic endometrium and in the regions of perivascular growth in myometrium compared to those areas in women with painless adenomyosis. Conclusions: Adenomyosis is a chronic inflammatory disease accompanied by dysfunction of the uterine immune reactivity. Inflammatory and immune processes in the uterus with adenomyosis contribute to the persistence and growth of endometrial implants. In adenomyosis, associated with chronic pelvic pain syndrome, there is increase in the number of activated macrophages, natural killer cells and T-helper cells in the perivascular regions and in areas of remodeling of the myometrium are carriers of the nerves, which leads to increased neurogenic inflammation and sensitivity of nociceptors, activation of peripheral nerve fibers and the generation of pain.

The aim of the present work was the immunohistochemical assessment of innervation apparatus and neuro-tissue relationship in the 60 uterus, which received after hysterectomy from patients with diffuse adenomyosis II–III degree, accompanied by severe pain. Visualization of nerve fibers was performed using mAb to neurofilament proteins. Based on these results the authors conclude that the main carrier of the nerves in the uterus and a potential cause of the formation of hyperalgesia at adenomyosis is myometrium with the formation of abnormally excessive innervation apparatus around foci of ectopic endometrium, in perivascular regions and in the stroma between the bundles of smooth muscle cells