Background. Given the frequent relapses of vulvar lichen sclerosus (VLS) and widespread resistance to treatment, the search for new pathogenetically grounded therapeutic options aimed at improving disease course and reducing the frequency of exacerbations is an urgent task of modern clinical medicine. Objective of the study: to evaluate the clinical efficacy of cholecalciferol as a systemic adjuvant immunomodulatory agent in addition to standard therapy with topical corticosteroids in patients with VLS and laboratory-confirmed vitamin D deficiency. Materials and methods. This prospective study included 100 women aged 18 to 70 years with a verified diagnosis of VLS and serum 25-hydroxyvitamin D levels below 30 ng/mL. The control group (n = 50) received standard monotherapy with topical corticosteroids clobetasol propionate 0.05%. The intervention group (n = 50) additionally received oral cholecalciferol at a dose of 10,000 IU/day for 12 weeks, followed by a maintenance dose of 4,000 IU/day. The follow-up period lasted 12 months, during which symptom severity was assessed using a visual analogue scale, and objective tissue changes were recorded. Results. The combined approach demonstrated a statistically significant advantage. Already after four weeks, a markedly faster reduction in visual analogue scale symptom scores was observed in the intervention group. Complete clinical remission was achieved in 42% of patients in the intervention group compared with 18% in the control group. After one year of follow-up, the relapse rate was 12% in the intervention cohort versus 38% in the control group. Objective examination confirmed significantly more active restoration of the elasticity of affected tissues, rapid epithelialization of existing microfissures, and sustained regression of hyperkeratosis under conditions of achieving target vitamin D concentrations. Conclusions. Normalization of nutritional status significantly slows the pathological progression of dermal sclerosis and effectively enhances the action of topical corticosteroids. Long-term cholecalciferol administration creates a favorable immunological milieu, which substantially reduces the overall relapse rate and promotes regeneration of squamous epithelium. Screening for vitamin D deficiency and its subsequent correction should be integrated into the management strategy for patients with VLS.
Objective of the study: to evaluate the clinical, anamnestic, reproductive, and hormonal characteristics of infertile patients with ovarian endometriomas depending on prior surgical treatment in assisted reproductive technology. Materials and methods. A retrospective cohort study was conducted involving 67 infertile patients who underwent evaluation and treatment using assisted reproductive technology programs between 2024 and 2026. Group 1 included 24 patients with ovarian endometriomas following surgical treatment; Group 2 included 23 patients with untreated ovarian endometriomas; and Group 3, the control group, included 20 patients with male-factor and/or absolute tubal infertility without endometriosis. Results. No statistically significant differences in age were found between the groups. At the same time, the groups differed in body mass index, age at menarche, and duration of infertility. Primary infertility was more common in patients with ovarian endometriomas, whereas secondary infertility predominated in the control group. Patients with endometriomas typically presented with dysmenorrhea and pre- and postmenstrual bleeding. The highest incidence of dysmenorrhea was observed in the group with untreated endometriomas. Regarding hormonal profile indicators, statistically significant differences were found in the levels of anti-Müllerian hormone and estradiol. The lowest anti-Müllerian hormone level was found in patients with endometriomas (0.61 ± 0.07 ng/mL), whereas in patients who had undergone surgical treatment it was 1.67 ± 0.28 ng/mL, and in the control group – 1.38 ± 0.14 ng/mL. Estradiol levels were highest in Group 2 – 143.5 ± 40.1 pg/mL. Conclusions. Infertile patients with ovarian endometriomas exhibit characteristic clinical and anamnestic features, including a higher prevalence of primary infertility, dysmenorrhea, and menstrual cycle disorders. The presence of untreated ovarian endometriomas was associated with a statistically significant decrease in anti-Müllerian hormone levels and an increase in estradiol levels. The results confirm the need for an individualized assessment of reproductive potential and ovarian reserve when planning assisted reproductive technology in patients with ovarian endometriomas.
Study of stress-associated pregnancy in Ukrainian women during war is of crucial importance for understanding the pathogenetic mechanisms of the negative impact of war factors on the woman's body before and during pregnancy. This is necessary for improving the health of both the mother and the child. During war, pregnant women require comprehensive protection, primarily psychological, as well as support for mental and physical health. Social support, art therapy, and behavioral interventions, including regular physical activity, balanced nutrition, and adequate fluid intake, are important because they positively affect the health of the brain and body. The use of prenatal vitamin-mineral complexes is important during pregnancy planning and throughout all trimesters to stabilize and support redox, metabolic, and enzymatic processes in the body. During wartime, consumption of folic acid at a dose of 800 Вµg per day is recommended, together with essential micronutrients, antioxidants, unsaturated fatty acids, and dietary fiber. During stress, disturbances in the lipid profile justify the use of polyunsaturated fatty acids for preventive and therapeutic purposes. Laboratory monitoring of women's health under stress conditions includes determination of calcium and magnesium levels in blood serum and 24-hour urine, monitoring of blood coagulation parameters and cortisol (as indicated: in blood, urine, hair, and saliva). After determining the content of magnesium and calcium in blood and 24-hour urine, intake of magnesium preparations is recommended. Calcium is not absorbed in the intestine at high cortisol levels. The use of vitamin D with simultaneous control of cortisol levels is justified. Thus, the use of magnesium preparations (Magnicum-Antistress) and vitamin D3 (Videin 4000 MU) is justified, with monitoring of their levels. Medically planned pregnancy is a crucial step in supporting the health of the mother and the child. Progesterone support before and during pregnancy with monitoring of its level is important. Although pregnancy is a physiological process, in wartime it becomes a source of stress due to artificially created circumstances, which requires preventive measures, including early medical planning with a personalized algorithm for managing each woman.
Objective of the study: to establish an optimal set of cytological criteria and to develop a mathematical algorithm to improve the effectiveness of the differential diagnosis of endometrial hyperplasia and cancer. Materials and methods. A preoperative examination of the endometrium was carried out in 32 patients with abnormal uterine bleeding by means of aspiration cytology, using a standardized assessment algorithm comprising 7 most informative cytomorphological features. Based on mathematical analysis and Bayes’ theorem, an expert diagnostic system was developed, defining weighting coefficients and threshold values for differentiating between endometrial hyperplasia and endometrial cancer. The cytology findings were verified by the results of the post-operative histological examination. Results. The comprehensive use of standardized cytological criteria in combination with a mathematical algorithm improves the accuracy of the differential diagnosis of hyperplastic and malignant processes of the endometrium. The most significant cytological criteria for differential diagnosis were found to be impaired cell polarity within structures, an increased nuclear-cytoplasmic index, abnormal nuclear and nucleolar shapes, irregular nuclear membranes, neoplastic features and the formation of three-dimensional cell structures. In the group of women aged 30–39 years, a low prevalence of endometrial cancer was confirmed. The summary coefficient did not reach the threshold level. In the 40–49 age group, an increase in the frequency of endometrial hyperplastic processes, polyps and abnormal uterine bleeding was observed. It was in this group that the first case of endometrial carcinoma was recorded. In the patient with a malignant endometrial tumor, the summary diagnostic coefficient significantly exceeded the threshold value (+195), indicating the presence of a complex of cytomorphological features characteristic of malignant transformation of the endometrium. In women aged 60–69 years, endometrial pathology was represented by both glandular hyperplasia and endometrial cancer. The total diagnostic coefficient significantly exceeded the established diagnostic threshold. Conclusions. The results obtained support the comprehensive use of cytological criteria and a mathematical algorithm for differential diagnosis, which helps to improve the accuracy of detecting precancerous and malignant changes in the endometrium and may be recommended for implementation in cytology laboratories and clinical settings.
Background. Patient autonomy in reproductive medicine should be understood not merely as a formal right to sign or withdraw consent, but as an ongoing process of informed clinical decision-making that includes understandable information about diagnosis, prognosis, alternatives, risks, expected outcomes, and the legal consequences of assisted reproductive technologies (ART). Objective of the review: to provide an integrated medico-legal analysis of mechanisms safeguarding patient autonomy in ART, to define the limits of permissible State interference, and to formulate practical criteria for valid informed consent. Materials and methods. This study is a narrative interdisciplinary medico-legal review. The source corpus included current Ukrainian legislation directly relevant to medical intervention, ART, and legal parentage; international human-rights instruments; selected European Court of Human Rights (ECtHR) case law; and clinical-ethical guidance issued by World Health Organization (WHO), European Society of Human Reproduction and Embryology (ESHRE), and American Society for Reproductive Medicine (ASRM) concerning informed decision-making in reproductive medicine. Ukraine, Germany, France, Italy, and the United Kingdom were compared descriptively using the following parameters: regulatory model, procedural safeguards for informed consent, access to selected ART procedures, regulation of gametes and embryos, and mechanisms of legal protection; no quantitative ranking of autonomy was used. Analysis of the literature. In Ukraine, the basic safeguards of autonomy derive from the Fundamentals of Ukrainian Health Legislation, the Civil Code, the Family Code, and the Procedure for the Application of Assisted Reproductive Technologies approved by Ministry of Health Order No. 787; however, the regulatory framework remains dispersed across instruments of different legal force. WHO, ESHRE, and ASRM guidance supports a process-based understanding of informed consent that includes discussion of alternatives, risks, expected outcomes, patient values, opportunities for questions, and the possibility of withdrawing consent. European Court of Human Rights (ECtHR) jurisprudence shows that reproductive autonomy is protected primarily through Article 8 of the Convention, while coercive reproductive interventions may, in sufficiently serious circumstances, engage Article 3. Conclusions. The article proposes a minimum structured model of informed consent for ART comprising clinical information, alternatives, medical and legal consequences, disposition of cryopreserved material, rules for modification or withdrawal of consent, verification of patient understanding, and documentation of shared decision-making. This model links legal safeguards of autonomy to the realities of clinical reproductive care.
