More than one million women in Russia enter menopause each year. The severe estrogen deficiency associated with this transition causes symptoms that significantly impair quality of life and contribute to an increased risk of cardiovascular and metabolic diseases. Menopausal hormone therapy (MHT) is the established standard of care for menopausal symptoms. On the initiative of several professional societies (the Russian Society of Obstetricians and Gynecologists, the Russian Society of Cardiology, the Russian Association of Endocrinologists, the Eurasian Association of Therapists, the Russian Society of Gynecological Endocrinology and Menopause, the Russian Association of Gerontologists and Geriatricians, the Association of Phlebologists of Russia), a Delphi panel was convened to develop a multidisciplinary expert consensus on MHT for patients with cardiovascular and metabolic diseases. The goal was to enhance research and clinical approaches to managing menopausal women. A consensus was reached at the end of the first Delphi round. The experts agreed that initiating MHT requires a thorough assessment of individual risks, including cardiovascular health and comorbidities. MHT can offset metabolic and cardiovascular risk factors in peri- and postmenopausal women by normalizing the lipid profile, improving carbohydrate metabolism, and reducing insulin resistance. An interdisciplinary approach allows for personalized MHT, minimizes potential complications, improves the quality of life for peri- and postmenopausal women, and promotes active longevity.

BACKGROUND : E2V/DNG is widely use in Russian clinical practice, although satisfaction of Russian patients and doctors has not been ever evaluated and analysed.AIM: To evaluate satisfaction in young women (18–35 years old) with a drug containing estradiol valerate/dienogest (E2V/ DNG) over a 6-month period in real clinical practice in Russia. MATERIALS AND METHODS : This was a prospective multicenter study (Q-SWAN – Qlaira, Satisfaction, WomAN [ClinicalTrials. gov: NCT04901377]) that assessed satisfaction of 504 women (average age is 27.8 years) with the contraceptive containing E2V/DNG. The characteristics of menstrual bleeding, sexual function, women’s decision to continue and satisfaction of doctors with this method of contraception were also assessed. RESULTS : It was found that 98.4% of women and 100% of doctors were “very satisfied” or “satisfied” with this method of contraception, regardless of the presence or absence of AUB. There was a significant decrease in the intensity, duration of menstrual bleeding and pain. Normalization of the parameters of the FSFI questionnaire was observed in most of the patients (89.7%). The contraceptive E2V/DNG was well tolerated by women, and the overall rate of adverse events was 7.1%. Most women (97.8%) decided to continue taking the medication after completing the study. CONCLUSION : The results of the study showed high satisfaction of young Russian women and doctors with the use of E2V/DNG, regardless of the presence or absence of AUB. The medication has a positive effect on the characteristics of bleeding/ cycle control and on the quality of sexual function, therefore, the women demonstrated a high adherence to this method of contraception.

Due to its effect on insulin resistance, ease of administration and favorable safety profile, metformin has been included in the recommendations of foreign medical communities for the management of pregnant women with hyperglycemia since 2008. However, in Russia, the use of any oral hypoglycemic agents during pregnancy is still contraindicated. However, recent studies demonstrate the safety and positive effects of metformin on pregnancy in patients with pregestational diabetes mellitus, polycystic ovary syndrome and gestational diabetes mellitus. In 2023, the Federal Service for Surveillance in Healthcare of the Ministry of Health of Russia updated the instructions for the medical use of Glucophage® and Glucophage®Long: pregnancy was excluded from the “Contraindications” section and moved to the “With caution” section. This resolution is intended to evaluate studies of the effectiveness and safety of metformin, as well as to study the experience of foreign colleagues and Russian legal aspects of prescribing metformin in the stages of preparation for pregnancy, during it and in the post-gravid period.

Background. One of the most prominent threats for masculine health is comorbidity between benign prostatic hyperplasia (BPH) and diabetes mellitus type 2. Many publications suppose influence of hyperglycemia on lower urinary tract obstruction. Question about influence of the most common oral glucose-lowering drugs – biguanides (metformin hydrochloride) and third-generation sulfonylurea (glimepiride) has not been answered yet. Aim. To assess whether glucose-lowering drugs affect risk of benign prostatic hyperplasia (BPH) in men with type 2 diabetes who initiated first-line treatment with either metformin or sulfonylurea monotherapy from 2012 until 2022 in the National Medical Research Center for Endocrinology. Materials and methods. Single centre, retrospective, comparative study. Retrospective analysis of in-/outpatient medical cards. Primary outcome measures: Rates of subsequent BPH, identified based on community prescriptions for BPH-related treatment or hospital BPH diagnoses, and rates of transurethral resection of the prostate (TURP). Rates in metformin hydrochloride and sulfonylurea users were compared overall and stratified by 6-month haemoglobin A1c (HbA1c) using Cox regression. Results. In 95 metformin initiators with a median follow-up of 10 years, the 10-year cumulative BPH incidence was 25.7% (25 cases; 95% CI 24.2–27.1). Compared with 95 sulfonylurea users [median follow-up 8 years, 10-year cumulative incidence 27.4% (17 cases; 95% CI 16.2–18.6)], the crude HR for BPH was 0.83 (95% CI 0.77–0.89) and adjusted HR in the ITT analyses was 0.97 (95% CI 0.88–1.06). For TURP, the adjusted HR was 0.96 (95% CI 0.63–1.46). In the as-treated analysis, adjusted HR for BPH was 0.91 (95% CI 0.81–1.02). Conclusion. Compared with sulfonylurea, metformin did not substantially reduce the incidence of BPH in men with diabetes.

BACKGROUND: It is important to evaluate the effect of androgen replacement therapy on glycemic control.AIMS: Assessment of the effect of transdermal testosterone therapy on glycemic control in men with hypogonadism and T2DM.MATERIALS AND METHODS: The prospective, comparative study included 300 men aged 55[49;61] years: men receiving both glucose-lowering therapy (GLT) and transdermal testosterone; and patients receiving only GLT. Observation period 1 year. A medical history, a questionnaire for symptoms of androgen deficiency, and measurement of total testosterone and glycated hemoglobin were carried out. Groups were compared using nonparametric methods.RESULTS: Patients receiving androgen replacement therapy in combination with GLT at both 6 and 12 months from the moment of inclusion in the study, they had a statistically significantly higher level of total testosterone and less severity of symptoms of androgen deficiency. When assessing the magnitude of changes in the studied parameters, it was found that patients receiving testosterone replacement therapy (TRT) were characterized by a statistically significantly more pronounced decrease in the level of glycated hemoglobin (average difference 0,3%). In 29 (20,4% (95% ДИ 13,8–27,0)) men who received only GLT, hypogonadism was eliminated. In 3 patients from the TRT group, a pathological increase in the level of total blood PSA was observed, and therefore TRT was discontinued. An increase in hemoglobin above the reference value (>172 g/l) was detected in 8% and 1,3% of men on TRT and without correction of hypogonadism, respectively, p=0,011.CONCLUSIONS: The combination of transdermal TRT and GLT has a positive effect on glycemic control, which is manifested by a decrease in glycated hemoglobin to a greater extent than when using GLT alone. Normalization of testosterone levels leads to a decrease in the symptoms of androgen deficiency, which is accompanied by an improvement in quality of life. Elimination of hypogonadism only with GLT is possible in a small number of cases.

Aim. Evaluation and correction of local antimicrobial protection factors in women with type 2 diabetes mellitus (DM 2) and chronic recurrent vulvovaginal candidiasis (rVVC). Materials and methods. The study involved 100 women undergoing outpatient follow-up at the age of 40.9±5.8 years, with a body mass index of 29.8±3.5. The period was 2022–2023. The examination included anamnesis, collection of anthropometric data, calculation of body weight, microscopic examination of smears from the cervical canal and vagina, Gram-stained before treatment, in the 1st and 3rd months after its completion, identification pathogenic microorganisms using PCR, colposcopy, ultrasound of the pelvic organs. Indicators of glycosylated hemoglobin in the subjects at the control points of the study: at 1 month the average values were 5.9±2.9%, at 3 months – 5.9±3.0%, the average value was 5.9±3.1%. Candida species were identified by the bacteriological method using Sabouraud dextrose agar (growth of colonies of fungi of the genus Candida in an amount of more than 103 CFU/ml). Immunological methods for studying antimicrobial protection factors included studying the number of neutrophil granulocytes (NG) on the surface of the mucous membranes of the vulva and vagina, their phagocytic and NBT-reducing activity in a latex test. Randomization of patients into groups: group 1 included 50 (50%) women with DM 2 who, as part of complex therapy for rVVC received the drug Genferon® 1 intravaginal suppository of 500 thousand units 2 times a day for 10 days and fluconazole 150 mg orally three times with an interval of 72 hours at the first stage of treatment; group 2 included 50 (50%) women who received therapy with fluconazole 150 mg three times with an interval of 72 hours. The maintenance anti-relapse course therapy in both groups included the use of fluconazole 150 mg once a week for 6 months. In group 1st anti-relapse therapy was supplemented by the administration of the drug Genferon® 1 intravaginal suppository of 500 thousand units at night 3 times a week for 3 months, after which the vaginal microbiota was corrected for 2 weeks using vaginal suppositories, containing Lactobacillus acidophilus in an amount of at least 108 CFU. In group 2nd, basic anti-relapse antimycotic therapy was not accompanied by the prescription of any immunomodulatory or probiotic drugs. Results. The etiological agents of rVVC in women of late reproductive age in 79% (n=79) и 28% (n=28), respectively, were C. albicans and C. glabrata, which during the period of acute of the disease were detected by culture in the vaginal discharge at more than 104 CFU/ml. Chronic recurrent course of vulvovaginal candidiasis in women with DM 2 was characterized by exacerbations 4 or more times a year, accompanied by the corresponding clinical picture: white or yellowish-white cheesy discharge from the genital tract, itching or burning in the anogenital area, discomfort in the external genital area, dyspareunia, dysuria, decreased phagocytic activity of NG in vaginal secretions by 25.8%, impairment of their spontaneous and latex-induced NBT-reducing activity by 35.2%, functional reserve by 23.0% relative to reference values. The use of the drug Genferon® as part of complex therapy for rVVC contributed to a decrease in the number of Candida spp. in 1st and 3d months of observation after completion of anti-relapse therapy, normalization of cellular factors of innate immunity of the mucous membranes, faster resolution of the clinical manifestations of an episode of the disease. The decrease in the number of relapses over a 12-month observation period compared to the control group was also facilitated by an increase in the protective properties of the vaginal mucosa due to the restoration of the vaginal microbiota with the help of lactobacilli acidophilus. Conclusion. The etiological agents of rVVC in women of late reproductive age are C. albicans and C. glabrata. Subcompensated DM 2 is a risk factor for rVVC, which requires additional monitoring of microbiological parameters of the vaginal microbiota. rVVC in women with DM 2 is associated with an increase in the number of NG in the vaginal secretion, a decrease in their phagocytic activity and functional reserve compared to the reference values. Combination therapy of rVVC with topical recombinant interferon α2b, benzocaine and taurine in the formulation of Genferon® (suppositories) is an effective method to improve the clinical and immunological efficacy of therapy.

Aim. To evaluate the efficacy of endovideoscopic urethra-sparing simple prostatectomy via an extraperitoneal approach (EUSP) for patients with benign prostatic hyperplasia. Materials and methods. In the period from January 2021 until September 2022 8 patients underwent EUSP. Initial clinical datas, perioperative and postoperative outcomes, implications, IPSS questionnaires, IIEF-5 and ejaculatory datas have been evaluated. The technique of the present method was adopted from Ping Wang, Dan Xia, SunYi Ye, DeBo Kong, Jie Qin, TaiLe Jing, YeQing Mao, HongZhou Meng, Shuo Wang (2018). Results. Seven (87.5%) patients underwent EUSP successfully, 1 (12.5%) patient needed conversion into open simple prostatectomy. Mean time of operation was 171 minutes (150–185), mean blood loss was 232 ml (180–300). In 2 (25%) cases urethral reconstruction after damage was needed. Mean catheterization time was 1.5 days (1–4). According to Clavien–Dindo classification (2004) such complications were found: low degree – 2 (1 or 2 group), 3а group – 1 (severe hematuria, when bladder infusion is needed). Mean management time was 8.4 months (6–11). Results from post-operative questionnaire IPSS (p0.1) и QoL (p0.1) significantly improved. Totally 4 patients had secure erectile function: 3 of them had normal erection, the last one (1) – retrograde ejaculation. Conclusion. EUSP is technically applicable for patients with benign prostatic hyperplasia. Patients have shorter time of catheterization, risk profile, significant improvement of urination и support of antegrade ejaculation.

Reproductive health care involves helping families in this area with the provision of the necessary information. This is recognized as a key step in improving the health of men, women and children and is a fundamental human right. Everyone has the right to have access to a correct understanding of reproductive health care, choice of contraceptive method and the opportunity to benefit from scientific progress in this area. Over the past 35 years, significant progress has been made in the development of new contraceptives: the content of hormones in combined oral contraceptives has significantly decreased, inert intrauterine contraceptives have been replaced by more progressive, levonorgestrel-containing ones including low-dose generation. Combined hormonal compounds were synthesized in the form of injections, patches and vaginal rings, progestogen implantable and injectable contraceptives. Women who use contraceptives must take into account the state of health (including the presence of endocrine pathology) in order to use them without harm to their health. Based on the World Health Organization Medical Eligibility Criteria for Contraceptive Methods 2015, the Russian Medical Eligibility Criteria for Contraceptive Methods 2023 is designed to become an important tool in daily practice of doctors.

By definition, contraception is the prevention of pregnancy and infection from diseases by mechanical, chemical and other contraceptives and methods. According to World Health Organization (WHO) statistics, up to 40% of women of reproductive age still believe that their needs for family planning services are not met during counseling. When recommending contraception, it is important to consider: the characteristics of the potential consumer, the underlying risk of the disease, possible undesirable drug reactions of various drugs, the cost, availability and preferences of the woman herself. Women are often forced to abandon the use of a contraceptive method in connection with adverse events, for example, when using combined oral contraceptives (COCs), they may feel worse (headaches, mood lability, weight gain, swelling, decreased libido) in a hormone-free interval, especially with the reception mode 21/7. Lack of contraception can lead to an increased risk of an unwanted pregnancy. According to statistics in the Russian Federation in 2018, the absolute number of abortions amounted to 567 183, which, according to the UN classification, corresponds to the average level (level of abortion rate per 1000 women of childbearing age). According to clinical practice, there is a relationship between deterioration of well-being and the duration of the hormone-free interval. At the moment, in our country there is the only COC, which has a hormone-free interval of 2 days, containing bioidentical estrogen estradiol valerate and dienogest. According to the Cochrane Library, COCs with a short hormone-free interval are most effective in relation to the clinical manifestations of the estrogen withdrawal syndrome. WHO calls on clinicians to raise womens awareness of modern methods of contraception.

The reproductive potential of a woman depends on indicators of the ovarian reserve, such as the anti-Muller hormone (AMH) and the number of antral follicles (NAF). Autoimmune diseases have a significant effect on fertility and contribute to the development of premature ovarian failure. Aim.To evaluate the parameters of the ovarian reserve in patients with type 1 diabetes mellitus, carriers of antibodies to the thyroid gland in a state of euthyroidism and compare them with similar parameters in healthy women. Materials and methods.In the first block of the study, the level of AMH, follicle-stimulating hormone, luteinizing hormone, NAF was studied among 224 women with diabetes and 230 healthy women in the control group. In block II, the level of the above hormonal indices was studied in 35 carriers of antithyroid antibodies in the state of euthyroidism and 35 healthy women. Results.In patients with type 1 diabetes, the level of AMH, NAF was statistically significantly lower when compared with the control group. Among carriers of antithyroid antibodies and healthy women, no difference in AMH and NAF was found. Conclusion.The autoimmune processes accompanying diabetes are more influenced by the ovarian reserve indices than autoimmune aggression to the tissues of the thyroid gland.

Life in a modern metropolis is not only an interesting and eventful life, but also a source of numerous features for human life: imperfect environmental conditions, dietary habits, sleep disturbances and circadian rhythms, changes in psychological status (stress, depression, aggression, apathy) and reproductive health problems, especially in women. As defined by the World Health Organization, reproductive health is a state of complete physical, mental and social well-being, and not simply the absence of disease in all areas related to the reproductive system, its functions and processes. Life in a big city for a woman of the reproductive period is often accompanied by a violation of the menstrual and ovulatory function, which can be attributed to the symptoms of the megalopolis syndrome. Since the 1980s, the frequency of menstrual irregularities has increased by more than 7 times. The doctor clinician, to whom a woman of the reproductive period with an irregular menstrual cycle first turns, should not only draw up a plan for examining a woman and exclude the presence of endocrine-gynecological disorders, but also collect a detailed history, including physical status (for example, calculating body mass index, analyzing fluctuations weight), dietary habits, sports history, medication intake, first assess the role of the psychosomatic factor. The correct pathogenetic approach in this situation will determine the correct therapeutic tactics for managing a woman.

The article describes the clinical case of diagnosing and choosing the tactics for treating ovarian adrenal rest tumors (OART) in a patient with a salt-wasting form of congenital adrenal hyperplasia (CAH). There are only several clinical cases descriptions of OART in the world literature. At present, the tactics of observation and treatment of the ovarian adrenal rest tumors has not been developed. In each case, individual tactics are chosen. The main predisposing factor to the occurrence of OART is considered to be long periods of decompensation of CAH. ACTH stimulates the hyperplasia and hypertrophy of the residual adrenal tissue in the ovaries and secondary tumors develop. The instrumental methods that allow to diagnose OART include ultrasound, MRI of the pelvic organs, PET with 18FDG. The tactics of treating OART, in contrast to the testicular adrenal rest tumors in men (TART), according to world literature are mainly surgical. Organ-preserving operations were performed, as well as the removal of tumors along with the ovary. Cases of a combination of adenocarcinoma and CAH are also described. Each new case of OART is unique and with the accumulation of international experience, a consensus will be developed.

Жизнь в современном мегаполисе – это не только интересная и насыщенная жизнь, но и источник многочисленных негативных последствий для жизни людей: неидеальная экологическая обстановка, особенности питания, нарушение сна и циркадных ритмов, изменение психологического статуса (стресс, депрессия, агрессия, апатия) и нарушения репродуктивного здоровья, особенно у женщин. По определению Всемирной организации здравоохранения, репродуктивное здоровье – это состояние полного физического, умственного и социального благополучия, а не просто отсутствие болезней во всех сферах, касающихся репродуктивной системы, ее функций и процессов. Жизнь в большом городе для женщины репродуктивного периода нередко сопровождается нарушением менструальной и овуляторной функции, что можно отнести к симптомам синдрома мегаполиса. С 1980-х годов частота нарушений менструального цикла выросла более чем в 7 раз. Врач-клиницист, к которому первично обращается женщина репродуктивного периода с нерегулярным менструальным циклом, должен не только составить план обследования женщины и исключить наличие эндокринно-гинекологических нарушений, но и подробно собрать анамнез, включая физикальный статус (например, расчет индекса массы тела, анализ колебания массы тела), пищевые привычки, спортивный анамнез, прием лекарственных препаратов, первично оценить роль психосоматического фактора. Верный патогенетический подход в данной ситуации определит корректную терапевтическую тактику ведения женщины.