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.

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content of hormones in combined oral contraceptives has significantly decreased, inert intrauterine contraceptives have been replaced by more progressive, levonorgestrel-containing ones including low-dose generation.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.

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.

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.

Согласно определению, контрацепция – это предотвращение беременности и заражения от болезней механическими, химическими и другими противозачаточными средствами и способами. По статистике Всемирной организации здравоохранения (ВОЗ) до 40% женщин репродуктивного возраста по-прежнему считают, что их потребности в услугах планирования семьи не удовлетворяются во время консультирования. Рекомендуя контрацепцию, важно учитывать: характеристики потенциального потребителя, базовый риск заболевания, возможные нежелательные лекарственные реакции различных препаратов, стоимость, доступность и предпочтения самой женщины. Женщины часто вынуждены отказаться от использования того или иного метода контрацепции в связи с нежелательными явлениями, например, при использовании комбинированных оральных контрацептивов (КОК) возможно ухудшение самочувствия (головные боли, лабильность настроения, увеличение массы тела, отечность, снижение либидо) в безгормональный интервал, особенно при режиме приема 21/7. Отсутствие контрацепции может привести к увеличению риска наступления нежелательной беременности. Согласно статистике, в Российской Федерации в 2018 г. абсолютное число абортов составило 567 183, что, согласно классификации Организации Объединенных Наций, соответствует среднему уровню (уровень частоты абортов на 1 тыс. женщин фертильного возраста). По данным клинической практики имеется зависимость между ухудшением самочувствия и длительностью безгормонального интервала при приеме КОК. В настоящий момент в нашей стране есть единственный КОК, у которого безгормональный интервал 2 дня, содержащий эстроген, идентичный натуральному – эстрадиола валерат и диеногест. Согласно данным Кокрейновской библиотеки КОК с коротким безгормональным интервалом максимально эффективны в отношении клинических проявлений синдрома «эстрогеновой абстиненции». ВОЗ призывает врачей-клиницистов повышать информированность женщин в отношении современных методов контрацепции.

In January 2020, the famous scientist biochemist-endocrinologist, MD, professor Nikolay P. Goncharov turned 85 years old. Nikolay P. Goncharov — one of the leading experts in the field of biochemical endocrinology and hormonal analysis; he developed and introduced in the framework of the Human Reproduction program an experimental model for evaluating the pharmacokinetics, mechanism of action, efficacy and safety of new steroid drugs and regulators of endocrine secretion of steroid hormones. The editorial board of the journal “Problems of Endocrinology” congratulates NP Goncharov on his anniversary, wishes him good health, success, prosperity, vitality, fortitude and many more years of fruitful activity.

The review article presents data on the effects of obesity on the female reproductive system and offspring of mothers with overweight or obesity, such as infertility, miscarriages, premature birth, stillbirth, congenital anomalies and prematurity, as well as a high risk of cesarean section. Obesity accompanies polycystic ovary syndrome, worsening the metabolic profile and increasing the risk of developing depression and eating disorders. Maternal obesity and hyperglycemia are able to influence the formation of the fetus by epigenetic mechanisms without affecting the nucleotide sequences. Subsequently, the metabolic and cardiovascular risks increase in the descendants of obese or overweight mothers and gestational diabetes. Patients with obesity are characterized by a folic acid deficiency and a deficiency of the luteal phase. Exogenous administration of these substances improves pregnancy outcomes and prevents congenital malformations.

The review article presents data on the effects of obesity on the female reproductive system and offspring of mothers with overweight or obesity, such as infertility, miscarriages, premature birth, stillbirth, congenital anomalies and prematurity, as well as a high risk of cesarean section. Obesity accompanies polycystic ovary syndrome, worsening the metabolic profile and increasing the risk of developing depression and eating disorders. Maternal obesity and hyperglycemia are able to influence the formation of the fetus by epigenetic mechanisms without affecting the nucleotide sequences. Subsequently, the metabolic and cardiovascular risks increase in the descendants of obese or overweight mothers and gestational diabetes. Patients with obesity are characterized by a folic acid deficiency and a deficiency of the luteal phase. Exogenous administration of these substances improves pregnancy outcomes and prevents congenital malformations.

Obesity is a recurring polyetiological disease. Overweight are 3060% of women of reproductive age, and 2527% are obese. By 2025, it is expected that 50% of women on our planet will be obese. Obesity in women of reproductive age is accompanied by a high frequency of anovulation, hyperandrogenism, menstrual irregularities, endometrial pathology, infertility. During pregnancy, this group of women has a higher risk of short term loss, including pregnancy in the outcome of assisted reproductive technologies. Weight gain and obesity can lead to decreased fertility in women. The body mass index of a woman of reproductive age negatively affects the course of pregnancy, namely: the risk of gestational diabetes, increased blood pressure, eclampsia, the pathological course of the birth act and the pathology of the newborn increase. Obesity in women of reproductive age is an independent risk factor for cancer: breast cancer and endometrial cancer, and also leads to a decrease in the survival rate for ovarian cancer. Obesity often accompanies polycystic ovary syndrome, which occurs in every 10th patient of reproductive age. The combination of these diseases increases the risk of cardiometabolic conditions such as impaired glucose tolerance, type 2 diabetes and dyslipidemia. Weight loss in these patients is a necessary component of complex therapy aimed at improving reproductive potential.

Obesity is a recurring polyetiological disease. Overweight are 30–60% of women of reproductive age, and 25–27% are obese. By 2025, it is expected that 50% of women on our planet will be obese. Obesity in women of reproductive age is accompanied by a high frequency of anovulation, hyperandrogenism, menstrual irregularities, endometrial pathology, infertility. During pregnancy, this group of women has a higher risk of short term loss, including pregnancy in the outcome of assisted reproductive technologies. Weight gain and obesity can lead to decreased fertility in women. The body mass index of a woman of reproductive age negatively affects the course of pregnancy, namely: the risk of gestational diabetes, increased blood pressure, eclampsia, the pathological course of the birth act and the pathology of the newborn increase. Obesity in women of reproductive age is an independent risk factor for cancer: breast cancer and endometrial cancer, and also leads to a decrease in the survival rate for ovarian cancer. Obesity often accompanies polycystic ovary syndrome, which occurs in every 10th patient of reproductive age. The combination of these diseases increases the risk of cardiometabolic conditions such as impaired glucose tolerance, type 2 diabetes and dyslipidemia. Weight loss in these patients is a necessary component of complex therapy aimed at improving reproductive potential.

Background. Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. Recently, the role of melatonin in the pathogenesis of this syndrome became widely discussed among the scientists, because there is an evidence of its impact on the reproductive function and maturation of oocytes.Aim. To study a informativeness of melatonin determination and its relationship with sleep disorders in PCOS.Materials and methods. The study involved 120 women aged 17–35 years: 60 patients with PCOS and 60 women without this disorder as controls. The level of melatonin in the blood, saliva and its metabolite in urine – 6 sulfatoximelatonin were analyzed. To identify sleep disorders survey was conducted using a questionnaire scoring subjective sleep characteristics.Results. Sleep disorders based on subjective scoring profiles sleep characteristics were identified in PCOS group (up to 70% of patients) regardless of BMI. The level of 6-sulfatoximelatonin in urine, nocturnal melatonin levels in saliva (at 3:00 AM) and melatonin in the blood were significantly higher in patients with PCOS compared with the control group regardless of BMI. The level of melatonin in follicular fluid was lower in patients with PCOS. There was a significant correlation of melatonin levels in the blood and the degree of sleep disorders according to the questionnaire scoring subjective sleep characteristics, the level of melatonin in saliva at 3:00 AM and a 6-sulfatoximelatonin in daily urine (p = 0.046).Conclusions. PCOS is polyetiology disease, and an important role in the formation and progression in which plays melatonin. Correlation of levels of this hormone in different body fluids suggests its systemic action and direct involvement in the regulation of reproductive function.