Vol 21, No 6 (2019)

The review article examines the physiological role of iodine, the daily need for iodine, food sources of iodine, discusses the problem of iodine deficiency in the world and Russia, and describes iodine deficiency diseases. Practical recommendations are given for diagnosing iodine deficiency by ioduria, thyroid volume, and thyroid status parameters. The important role of iodine during pregnancy and lactation is presented, recommendations are made for filling iodine deficiency in pregnant and lactating women. The effect of iodine on the hormonal balance in a woman’s body, the role of iodine deficiency in the pathology of the mammary glands is considered. Iodine deficiency leads to the development of mastopathy and increases the risk of breast cancer. Practical recommendations are given on the use of iodine preparations in the treatment of benign breast disease and the prevention of breast cancer. The advantages of organically bound iodine over inorganic iodine compounds are discussed. The use of the drug Mamoclam®, containing organically bound iodine, in the treatment of benign breast disease is described.

Anemia remains one of the main extragenital diseases that complicate the course of pregnancy and the postpartum period. Modern possibilities in the diagnosis of iron deficiency states make it possible to predict possible pathology at earlier stages. The currently existing medical prophylaxis and therapy of iron deficiency improve the outcome of pregnancy, childbirth, the postpartum period, which improves the quality of life of woman and the economic cost of inpatient treatment.

Polycystic ovary syndrome (PCOS) is a heterogeneous pathology characterized by chronic anovulation, hyperandrogenism, oligomenorrhea, obesity, and infertility. Diagnosis and treatment of infertility in PCOS still is unsolved problem for modern reproductive medicine. Complications of pregnancy after assisted reproductive technologies in patients with PCOS such as miscarriage, premature birth, gestational hypertension and pre-eclampsia, fetal growth retardation and SGA fetus or gestational diabetes mellitus with macrosomia continue to be a huge problem in modern obstetrics. We describe a clinical case of cervical insufficiency in a patient with PCOS and its correction before embryo transfer by with hysteroscopic cervical cerclage.

The article presents current data on the mechanisms of influence of the progesterone receptor selective modulator - ulipristal acetate on myomatous nodes and its role in the treatment of uterine fibroids. Issues of efficacy and safety of use, as well as reproductive outcomes of therapy are covered.

Abnormal uterine bleeding of puberty (AUBP) is pathological bleeding from the uterine body and cervix due to functional or structural changes in the endo- and myometrium in girls aged menarche to 17 years inclusive. Aim. Evaluation of the efficacy of using the drug Dimia® (drospirenone + ethinyl estradiol) for AUBP and improvement of treatment outcomes at uterine bleeding in female adolescents. Materials and methods. A clinical study was conducted in Morozov Children's City Clinical Hospital of the Moscow City Health Department. The study involved 50 female adolescents aged 13-17 years (average 14.7±1.1 years) with various types of AUBP. The main group included 25 patients who received drospirenone + ethinyl estradiol (Dimia®), the control group included 25 (50%) patients who received conservative hemostatic therapy. In the main group, the drug was prescribed according to the standard regimen (1 tablet 2 times a day for 10 days). Results. Evaluation of the therapy efficacy was carried out during the entire course of treatment, i.e. daily for 10 days. With Dimia® therapy in the main group, a decrease in a volume of blood loss was observed on the 2nd day of treatment. In 24 (99%) patients, hemostasis was achieved on the 3rd day of treatment. In 8 (30%) patients of the control group who received conservative therapy, complete hemostasis was achieved by the 10th day of treatment and the remaining patients showed anemia of varying severity due to progressive bleeding. This group of patients was subsequently transferred to hormone therapy with Dimia® along with taking anti-anemic drugs. At the end of treatment, a control blood test showed that the hemoglobin levels averaged 121 g/l (±7 g/l), while the initial levels averaged 103 g/l (±7 g/l). After a 10-day course of treatment, control pelvic ultrasound and assessment of blood parameters were performed in all patients of both groups. In order to fully assess the quality of life of patients with AUBP in the future, all girls in both groups were prescribed maintenance therapy. The main group received supporting therapy with Dimia® according to the contraceptive regimen for 3-6 months; the control group was prescribed cyclic vitamin therapy for 3 months. At the end of therapy, patients of the 1st group noted a significant reduction not only in the duration of menstruation, but also in the volume of blood lost. In addition, these patients observed an improvement in skin condition and an increase in the quality of life. Conclusions. The study showed a significant improvement in treatment outcomes at abnormal uterine bleeding in female adolescents, as well as a decrease in menstrual blood loss. In accordance with the study results, it can be stated that the drug Dimia® (drospirenone + ethinyl estradiol) is effective not only at AUBP, but can also be used as a prevention and treatment for endometrial hyperplastic processes in female adolescents.

The article presents modern classifications of physiological and pathological vaginal discharge as well as a questionnaire table for clarification of various factors that resulted in symptoms onset. Diagnostic and treatment methods for urogenital chlamydiosis, trichomoniasis, bacterial vaginosis, and candida infections are presented according to international protocols and Russian guidelines.

Preservation of women’s health in different age periods, especially in the time of menopausal changes is one of the pressing problems in gynecology. Genitourinary menopausal syndrome is a complex of symptoms developing in estrogen-dependent tissues in women not only of peri- and postmenopausal age but also at time of lactation amenorrhea and treatment of genitourinary system hormone-associated disorders in reproductive age. The pathogenic basis for syndrome therapy is the use of estrogen-containing preparations for topical use. Although some women have contraindications for estrogens use because of impaired extragenital physical status. Platelet-rich plasma (PRP) therapy is widely used as an alternative treatment method.

Due to the morpho-functional changes in the woman’s body that occur during the postmenopause, the risk of osteoporotic fractures increases. Given the interdisciplinarity of the problem of osteoporosis, an important role is played by a comprehensive approach to the management of patients with this pathology, including the interaction of various specialists (gynecologist, rheumatologist, endocrinologist). In the correction of osteoporotic changes, it is necessary to adhere to the individual selection of drug therapy, taking into account the benefits and risks of the drugs used. The article presents a modern view on the treatment of osteoporosis in postmenopausal women. The data presented is based on updated clinical guidelines of the European Society of Endocrinology, published in March 2019, as well as on meta-analyzes of recent research on treatment issues. Attention is paid to the selection criteria for the use of a particular group of anti-osteoporotic drugs.