No 11 (2014)

Whatever the cultural and socioeconomic level is, most women perceive psychosomatic and behavioral changes before menstruation. This phenomenon is called premenstrual syndrome (PMS) when the discomfort is so great that it impairs day-to-day activity, relations with the present, and quality of life in a woman. Premenstrual dysphoric disorder is a severe form of PMS. Eating misbehavior that is to some extent responsible for weight fluctuations before menstruation and occasionally takes on the nature of mental disorder is described among the premenstrual symptoms. Eating misbehavior depends on fluctuations in the hormonal profile and on changes in the ratios of steroid hormones. This offers possibilities of using combined estrogen-gestagen contraceptives to treat hormonal imbalance-dependent eating behavioral disorders. The effects of hormonal contraceptives are known to be determined by the pharmacological properties of progestins that enter into their composition. The fourth-generation progestin drospirenone has a unique spectrum of antimineralocorticoid and antiandrogenic activities, which endows drospirenone-containing agents with peculiar therapeutic and preventive effects that are important in eating misbehavior as well.

The article considers possibilities and promises for using laser technologies in urogynecology. It analyzes clinical trials using laser in different areas of medicine, poses problems, and shows how to solve them, by developing and introducing into a gynecologist’s practice the highly effective and safe laser technologies affecting the vaginal and vulvar mucosa, which are based on the lasers of global considerable use.

Symptoms of vulvovaginal atrophy (VVA), such as vaginal dryness, burning, itching, and discomfort, painful and burning urination, dyspareunia, and bloody vaginal discharge during sexual intercourse, disturb as high as 57% of postmenopausal women. But despite the wide prevalence and dramatic progression of this condition, required therapy is performed in about 25% of women in western countries and in much fewer women in others. One of the reasons for the existing situation is that the patients are unaware of the high efficiency and safety of local treatment for VVA.

Objective. To obtain experimental data on urinary proteome in women with physiological pregnancy in order to enhance the diagnostic value of urinary markers for different diseases. Subjects and methods. Urine was sampled from 10 non-pregnant women aged 24 to 34 years to standardize a urine collection protocol. The investigators chose a second morning specimen as an object for urinalysis and 20 minutes as the recommended time for the ice storage of the object before pretreatment. For the standardization of the urine sampling protocol for pregnant women to make a further proteomic analysis, urine specimens were taken from 10 women aged 23 to 35 years at 15-17 weeks of normal pregnancy with the total urinary protein quantity of no more than 100 μg/ml (no proteinuria). The urinary specimens were analyzed using an Agilent 1100 nanoflow high-performance liquid chromatograph (nano-HPLC) (Agilent, USA) and a Finnigan LTQ FT mass-spectrometer (ThermoElectron, Bremen, Germany). Results. A protocol to isolate protein extracts from urine specimens, which involves a procedure for primary urine sampling from female patients and extraction of protein mixtures from the urine specimens, was developed and standardized. This investigation showed the high reproducibility and informative value of urinary proteome data in the pregnant women, which allows us to propose this protocol to determine pregnancy-associated urinary proteomic changes and characteristic qualitative ones in the urine protein profile during pregnancy and to investigate whether the found protein molecules might be used as biomarkers for the early diagnosis of different pregnancy-related diseases.

The present-day study of gluten-sensitivity celiac disease (GCD) could establish the autoimmune nature of small bowel mucosal inflammation and its relationship to reproductive disorders in women of childbearing age. Objective. To determine the rate of GCD, as well as its clinical symptoms in women with recurrent miscarriage. Subject and methods. The investigation enrolled 217 women (mean age 30.5±5.8 years) with recurrent miscarriage who had been followed up at the Research Center for Obstetrics, Gynecology, and Perinatology jointly with the Central Research Institute of Gastroenterology. The enzyme-linked immunosorbent assay was used to study IgA-class anti-α-gliadin and anti-tissue transglutaminase (anti-tTG) antibodies for the serological verification of GCD. Its diagnosis was histologically verified in the presence of elevated antibody levels, by applying 3-5 small bowel mucosal fragments obtained from the distal duodenum during esophagogastroduodenoscopy. Results. Examination of the 217 women with recurrent miscarriage established the diagnosis of GCD in 9 (4.1%) of them, which exceeds the population-based value (0.6-1%). The intestinal manifestations of the disease, weak- ness, and decreased working capacity were significantly more frequently encountered in the women with the verified diagnosis of GCD than in those with normal antibody levels. The clinical manifestations of malabsorption did not significantly differ in both groups. A gluten-free diet (GFD) could normalize intestinal function in the women with recurrent miscarriage and successfully prolong pregnancy during therapy. Conclusion. Among the women with recurrent miscarriage, the GCD detection rate of 4.1% significantly exceeds the population-based value (0.6%). GFD used in celiac disease patients having reproductive disorders contributed to recovered reproductive function and a favorable pregnancy outcome. Higher anti-tTG antibody titers in women with reproductive disorders are an indication for the histological examination of the small bowel mucosa in order to identify gluten-sensitivity celiac diseases.

Objective. To study the impaired expression of β-catenin, E-cadherin, and ezrin in different forms of endometrial hyperplasia, endometrial intraepithelial neoplasia, and low-grade endometrioid adenocarcinoma. Subjects and methods. Examinations were made in 45 patients who formed 5 groups: 1) simple endometrial hyperplasia (HE) (n = 12); 2) complex endometrial hyperplasia without atypia (CEH) (n = 9); 3) complex endometrial hyperplasia with atypia (CEHA) (n = 5); 4) endometrial intraepithelial neoplasia (EIN) (n = 5); 5) low-grade endometrioid adenocarcinoma (EAU) (n = 4). A control group consisted of 10 patients with the proliferative endometrium. The expression of Ki-67, PTEN, β-catenin, E-cadherin, and ezrin was immunohistochemically assessed. Results. As the disease progresses from simple HE to EAC, the loss of specific membrane localization of β-catenin, E-cadherin, and ezrin occurs, which reflects their lower functional activity. The altered localization of β-catenin, E-cadherin, and ezrin gives rise to impaired intercellular contacts during tumor progression. EIN has been established to be characterized by not only morphological features concurrent with the loss of PTEN expression, but also by the loss of membrane β-catenin, E-cadherin, and ezrin expression. Conclusion. The molecular and morphological features of CEHA and EIN are largely stereotypical, including the loss of membrane localization of β-catenin, E-cadherin, and ezrin from simple HE to EAC, but distinct in the expression of the β-catenin, E-cadherin, and ezrin genes in the cytoplasm of epithelial cells in EAC and in the expression of PTEN. Lower membrane β-catenin, E-cadherin, and ezrin expression in EAC may be related to the process of epithelial-mesenchymal transformation underlying a readiness for invasive growth in EIN and the invasive growth itself in EAC. The obtained results of clinicoanamnestic, diagnostic, and immunohistochemical studies in the above patient groups can substantiate a differential approach to choosing a treatment policy for patients with different forms of EH, EIN, and EAC.

Objective. To evaluate the impact of ovarian stimulation and to estimate the level of serum progesterone (P) in the late follicular phase of the cycle in GnRH agonist protocols on endometrial receptivity. Subjects and methods. Morphological and immunohistochemical (IHC) examinations were made of 50 endometrial biopsy specimens, including 28 ones obtained on the day of oocyte aspiration in the therapeutic cycle of IVF without further embryo transfer (a study group) and 22 ones taken in the natural cycle (the day of luteinizing hormone + 7) (a comparison group). Ovarian function was stimulated according to the standard long protocol using recombinant follicle-stimulating hormone and human menopausal gonadotropin. Serum P concentrations were determined on the day of ovulation triggering. The serum P threshold value was used to identify premature lutein-ization, which was equivalent to 4.77 nmol/l. The patients were divided into groups according to the level of P on the day of human chorionic gonadotropin administration: 1) Р ≥ 4.77nmol/l (n = 13); 2) P< 4.77nmol/l (n = 15). Results. On the day of oocyte aspiration, most (75%) of the patients were observed to have secretory transformation of the endometrium, as well as mature or regressing pinopodia on more than 20% of the endometrial surface in 100% of cases, which was similar to the implantation window in the natural cycle. IHC examination of the endometrium indicated that on the day of oocyte aspiration the expression of progesterone receptors (PR) in the endometrial glands (142.1±8.1%) was similar to the natural cycle during the implantation window (112.5±15.1; р = 0.470); that in the stroma was substantially lower (144.2±7.8 and 176.8±7.7, respectively;р = 0.001). In the stimulated cycle, the amount of estrogen receptors (ER) in the glands and stroma averaged 128.9±4.1 and 27.8±4.1%, respectively. In the implantation window of a natural cycle, the expression of ER in the glands was considerably lower (mean 92.9±12.0%;р = 0.018); it was much higher in the stroma (mean 66.1±9.3%;р = 0.001). In the stimulated cycle, the expressions of leukemia inhibitory factor in the surface epithelium and endometrial stroma (2.2±0.5 and 2.3±0.3) corresponded to those in the implantation window in the natural cycle (3.75±0.5 and 3.2±0.4;р = 0.07 and р = 0.180) and significantly lower in the glands and pinopodia. The results of endometrial dating using the Noyes criteria demonstrated that in the patients with a serum P level of < 4.77 nmol/l on the day of ovulation triggering, the endometrium on the day of oocyte aspiration was equal to 15.2±0.5 days of the cycle, by advancing the development by an average of 2.6±0.4 days; the endometrium at Р ≥ 4.77 nmol/l, was equal to 17.4±0.6 days of the cycle, by advancing the development by an average of 4.09±0.6 days (р = 0.023 and р = 0.048). The expressions of PR in the glands (126.6±13.1%) and stroma (130.6±12.8%) with normal P levels on the day of ovulation triggering were much lower than those in the elevated P group (160.0±5.9% (in the gland); р = 0.042; 163.3±5.4% (in the stroma); р = 0.041. The expression of ER in both the glands and stroma was similar in the groups. That of LIF in the endometrial stroma was significantly higher in the patients with elevated P levels (3.2±0.5 and 1.6±0.4 scores; р = 0.05). Mature pinopidia on the day of transvaginal oocyte retrieval were detected with an equal frequency in patients with normal or higher P levels (93.3% and 92.3%; р = 0.918). Conclusion. Ovarian stimulation in the IVF programs and as a result an anticipatory increase in P levels give rise to advanced endometrial maturation, as demonstrated by the detection of secretory transformation of the endometrium on the day of oocyte aspiration, mature pinopidia, decreased ER expression in the stroma, and early LIF expression in the epithelium and stroma.

The paper gives the data available in the literature on abnormal menopause, clinical manifestations of climacteric syndrome, and possible complications of menopausal hormone therapy. It describes experience in using magnesium preparations in complex nonhormonal treatment of climacteric syndrome. Co-administration of phytoestrogens with magnesium organic salts preparations (magneB 6) is most effective.

Anemia is the most common health care problem, among women in particular. Lower hemoglobin count may be caused by a lot of factors, among which deficiency of trace elements has been recognized as essential for normal erythropoiesis. Irrespective of age, the main causes of anemia are deficiency of iron and folic acid, less frequently vitamin B 12. The etiology of each deficiency state may vary in different periods of a woman’s life, but the importance of clinical sequels of anemia is a maximum for reproductive-aged women, i.e. the negative effects of a deficiency affect not only their organism, but also pregnancy outcomes and neonatal health. Therapy regimens using iron, folic acid, B 12 or their combinations have been elaborated and practically introduced to prevent and correct deficiency states in reproductive-aged women.

Objective. To evaluate the efficacy of tranexam 1.0 g used before organ-sparing surgery in patients with fibrinolytic coagulation abnormalities. Subjects and methods. One hundred and twenty patients with uterine myoma in whom laparoscopic myomectomy had been performed by one surgical team were followed up. Their mean age was 32.5±3.7 years. The fibromatous nodules measured 3.0 to 5.5 cm and were subperitoneal or intermuscular; at the same time one of the nodules showed centripetal growth. The examinees were divided into two equal groups of 60 persons in each. According to the developed invention procedure (Priority Certificate dated 20 February 2014; Application No. 2014106575(010377), 30-45 minutes prior to surgery, the patients of one group received intravenous injections of 1.0 g of tranexam diluted in 200 ml of 0.9% of sodium chloride solution for 20-30 minutes. Tranexam was not administered to the patients of the other group. Blood loss volume was estimated using a gravimetric method and considering the changes in laboratory parameters. Results. There was a 2-3-fold decrease in total blood loss in the women who had received tranexam preoperatively as compared to those who had not. In addition to a clinical observation and gravimetric calculation of blood loss, laboratory tests also proved the positive effect of tranexam on its reduced perioperative amount. Conclusion. Tranexam 1.0 g used in patients with blood fibrinolytic coagulation abnormalities before organ-sparing surgery is effective and safe in preventing coagulopathic bleeding and reducing in total perioperative blood loss.