Aim: To assess the severity of menopausal symptoms and quality of life in patients with iatrogenic menopause depending on the therapy. Design: A randomised parallel group clinical study. Materials and methods. The study enrolled 60 patients of reproductive age with iatrogenic menopause following bilateral ovariectomy who had a history of reproductive tumours. The patients were randomised into 2 groups. Group 1 (n = 34) was treated with escitalopram as follows: 5 mg once daily — 7 days, 10 mg once daily — 2 weeks, then 10 mg daily (subgroup 1а) or 20 mg daily (subgroup 1b) — 12 weeks. A dose of 20 mg daily was used where the frequency and severity of menopausal symptoms did not fall below 50 % in 3 weeks with a dose of 10 mg daily. Group 2 patients (n = 26) were prescribed an herbal product called cimicifuga racemosa essence (BNO 1055) at a dose of 6.5 mg 1 tablet once daily for 15 weeks. The patients' condition was assessed using a daily hot flash questionnaire; Quality of Life Questionnaire SF-36; Greene Climacteric Scale; and Insomnia Severity Index. Results. The number of hot flushes reduced in all subgroups; however, the reduction was statistically significant only in subgroup 1a. Greene Climacteric Scale showed that following 15 weeks of therapy in subgroup 1a there was significant reduction in the intensity of menopausal symptoms, anxiety and depression, improved somatic signs, reduced severity of vasomotor symptoms, and improved libido vs. baseline. Subgroup 1b patients demonstrated statistically significant reduction in menopausal symptoms and anxiety. Group 2 had marked reduction in menopausal symptoms and depression. Intergroup comparison demonstrates that the most marked effect from the therapy on menopausal symptoms, anxiety, depression and severity of vasomotor symptoms was observed in subgroup 1а vs. subgroup 1b and group 2. Quality-of-life assessment showed significant improvement in the physical component in group 2 patients, while psychological improvements were better in subgroup 1а after 15 weeks of therapy. Subgroup 1a patients had significant reduction in Insomnia Severity Index, while subgroup 1b and group 2 patients did not demonstrate any significant reduction in this parameter. Conclusion. Patients, for whom hormonal menopause therapy is contraindicated, including patients with hormone-driven malignancies, require therapy to improve their quality of life, manage their menopausal syndrome, correct psychoemotional state and improve sleep. The study demonstrated efficacy both of non-hormonal antidepressant escitalopram (a selective serotonin reuptake inhibitor) and BNO 1055 essence (a medicinal product). In mild and moderate menopausal syndrome, it is recommended to use BNO essence, while severe cases should be treated with 10 mg escitalopram daily, and therapy efficacy should be assessed after 3 weeks of therapy. Key words: menopause, malignancies, menopausal syndrome, selective serotonin reuptake inhibitor, antidepressants, cimicifuga racemosa, BNO 1055.

Recurrent urinary tract infections (RUTI) occur in 10-15 % of women of reproductive age and in 20 % of menopausal women and have an extremely negative impact on quality of life. Urinary tract infections (UTIs) account for about 40 % of all hospital-acquired infections and 50% of bacterial infections resulting in long-term hospitalisation. In Russia, 26-36 million cases of acute cystitis are reported each year. Because of its high prevalence, UTI is an economic problem. Clinically, UTI is more often manifested as acute urethritis or cystitis. Antibiotic therapy is a fundamental treatment for RUTI, but has a number of negative consequences. Antimicrobial resistance is an enormous challenge and a serious threat to global health, prompting the search for alternative strategies. Natural antimicrobial peptides have attracted the attention of researchers and clinicians for their broad therapeutic potential against bacteria, viruses and resistant intracellular bacterial communities (biofilms). This review details the etiology, classification, diagnosis and therapy of RUTI. Global data revealing the mechanisms of action of antimicrobial peptides is presented. Commercially available peptide-based antimicrobials and their efficacy based on clinical trials are discussed. The development of new strategies to combat bacterial infections, in particular the use of drugs based on antimicrobial peptides and their derivatives, has been shown to be of great practical importance in terms of combating multidrug-resistant pathogens and increasing the effectiveness of treatment of recurrent infections.

Recurrent urinary tract infections (RUTI) are one of the most common manifestations of the genitourinary menopausal syndrome and occur in more than 20% of peri- and post-menopausal women. The most common risk factor for RUTI in peri- and post-menopausal women is sex steroid deficiency. The urinary and genital tracts share a common embryonic origin due to the presence of α- and β-estrogen receptors, progesterone and androgen receptors in all structures of the urogenital tract: lower third of the ureters, urinary bladder, vascular plexus, urothelium, pelvic floor muscles, pelvic ligamentous apparatus. Patients with RUTI are treated in two stages: treatment of exacerbations and prevention of relapses. During exacerbations, short courses of antibiotic therapy are administered according to the sensitivity of the bacterial agent. If microbiological testing of urine samples is not possible, antibiotics are selected empirically, taking into account the most common pathogens of a UTI. Vaccine prophylaxis is the leading method of preventing a UTI recurrence. The efficacy and safety of E. coli bacterial extracts have been proven in numerous RCTs. The Uro-Vaxom vaccine reliably reduces the incidence of cystitis recurrence, reduces the need for antibacterial drugs, and therefore improves the quality of life of menopausal women with RUTIs. Vaccine prophylaxis in menopause can be administered as monotherapy or in combination with topical estrogen therapy, which also plays a positive role in the treatment of urinary tract infections.

Young women with reproductive tract neoplasms who receive treatment leading to termination of ovarian function often suffer from menopause symptoms that contribute to dramatic drop in quality of life. Climacteric symptoms in women with iatrogenic menopause are more severe than in case of natural menopause, especially in women with reproductive tract neoplasms. They lead to dramatic drop in quality of life and are one of the main reasons to stop applying endocrine therapy in women with hormone-positive tumors, which leads to decrease in disease free survival and to decline the prognosis. The most effective treatment option for climacteric symptoms of moderate to severe degrees is menopause hormone therapy; however, such therapy is not suitable for patients with estrogen-dependent tumors in past medical history due to the likelihood risk of progression of cancer, as well as the risk of venous thrombosis, the frequency of which in cancer patients increases. Non-hormonal pharmacological and non-pharmacological correction methods are used as first-line therapy for menopause disorders in women with estrogen-dependent tumors of the reproductive system. Among non-hormonal non-pharmacological correction methods actively study such methods as acupuncture, yoga, exercise to control weight, and a diet rich in phytoestrogens. The most effective non-hormonal methods of correcting vasomotor symptoms are serotonin and norepinephrine reuptake inhibitors. However, currently in Russia these drugs can be prescribed only by a psychiatrist. The finding of effective and safe non-hormonal methods to correct menopause symptoms in women with hormone-positive reproductive tract tumors is the important task in practice among doctors in different specialties.

Молодые пациентки с онкологическими заболеваниями органов репродуктивной системы, которые получают лечение, приводящее к выключению функции яичников, часто страдают менопаузальными симптомами, способствующими резкому снижению качества жизни. Климактерические симптомы при ятрогенной менопаузе значительно более выражены по сравнению с симптомами, возникающими после естественной менопаузы, особенно у пациенток с онкологическими заболеваниями органов репродуктивной системы. Они приводят к резкому снижению качества жизни и являются одной из основных причин прекращения эндокринной терапии у пациенток с гормон-позитивными опухолями, что приводит к снижению безрецидивной выживаемости и ухудшению прогноза. Наиболее эффективным методом лечения климактерических симптомов средней и тяжелой степени является менопаузальная гормональная терапия, однако она противопоказана пациенткам с эстрогензависимыми онкологическими заболеваниями в анамнезе ввиду вероятности прогрессирования онкологического заболевания, а также риска венозных тромбозов, частота которых у онкологических больных повышается. В качестве 1-й линии терапии менопаузальных расстройств у женщин с эстрогензависимыми онкологическими заболеваниями органов репродуктивной системы используются негормональные фармакологические и нефармакологические методы коррекции. Среди негормональных нефармакологических методов коррекции активно изучаются иглоукалывание, йога, физические упражнения для контроля массы тела, а также диета, богатая фитоэстрогенами. Наиболее эффективными негормональными методами коррекции вазомоторных симптомов являются селективные ингибиторы обратного захвата серотонина и селективные ингибиторы обратного захвата серотонина и норадреналина. Однако в настоящее время на территории России данные препараты могут быть назначены только врачом-психиатром. Поиск эффективных и безопасных негормональных методов коррекции менопаузальных симптомов у пациенток с гормон-позитивными опухолями органов репродуктивной системы является важной задачей в практике врачей разных специальностей.

Aim: Presentation of basic clinical scientific data based on modern evidence of anatomical and physiological changes in the urogenital tract in periand postmenopause and the principles of management of women with genitourinary menopausal syndrome.Material and methods: The review of domestic and foreign sources devoted to prevalence, modern diagnostics and methods of vaginal atrophy treatment was carried out.Results: the present article contains modern terminology, data on etiopathogenesis, clinic, diagnostics and treatment methods of VVA, clinical examples.

He purpose of the review - presentation of basic clinical scientific data based on current evidence on the management of patients with mixed urinary incontinence. Material and methods. A review of Russian and foreign sources on the prevalence, etiopathogenesis, diagnosis and treatment of mixed urinary incontinence in women. Results. The review presents terminology, data on etiopathogenesis, clinic, diagnosis, phasing and treatment methods of mixed urinary incontinence in women at different age periods.

The purpose of the review - presentation of clinical scientific data based on current evidence of information on the management of patients with stress urinary incontinence, the effectiveness and safety of periurethral injections of various bulking substances. Material and methods. А review of Russian and foreign sources on the prevalence, etiopathogenesis, diagnosis and treatment of stress urinary incontinence in women, in particular the injection method. Results. The review presents data of the etiopathogenesis, diagnosis and treatment of stress urinary incontinence in women, depending on the severity of the pathology. Analyzed the data of periurethral injection of various bulking materials, their effectiveness and safety.

The aim of the study was to investigate the dynamics of atrophic changes оn the use of low-dose regimens of local therapy with a druge containing only estriol and a druge containing estriol, progesterone and a culture of lactobacilli in patients with postmenopausal vulvovaginal atrophy on the basis of subjective and objective criteria. Materials and methods. 44 patients with vulvovaginal atrophy were randomized into 2 groups of 22 people. In the first group, a drug containing estriol in a dose of 0.5 mg was used, in the second group, a preparation containing a lyophilized culture of lactobacilli, estriol - 0.2 mg; progesterone - 2.0 mg was used. Methods of the study included questioning of patients, cytological examination of the vaginal wall with evaluation of the epithelial maturation index, pH-metrics of the vaginal secretion, definition of the vaginal health index (IVS), PCR diagnostics of the vaginal biocenosis. Results. The use of a low-dose regimen of local therapy with estriol contributed to the restoration of the vaginal epithelium, which was confirmed by a statistically significant increase in ISEV and IVS, in the number of lactobacilli and a decrease in pH, However, the use of a combination drug led to a more effective recovery of lactoflora and normalization of the vaginal microflora.

Menopause is the final cessation of menstrual cycles due to loss of follicular activity of the ovaries. According to the results of a meta-analysis of 36 studies performed in 35 countries, the average age of menopause onset is 48.8 years (95% CI 48,3 – 49,2) with significant fluctuations of this indicator depending on the geographical region of residence of women: lower in Africa, Latin America and middle East countries (47,2–48.4 years) and later in Europe and Australia (50,5–51,2 year) [1]. The number of women in peri- and postmenopausal phase in connection with the increase in life expectancy is increasing. In Russia it is currently more than 21 million. The average age of the menopause onset in Russia ranges from 49 to 51 years, at the same time women live in conditions of estrogen deficit for 1/3 of their life [2, 3].

Purpose of the study - to evaluate the effectiveness of black cohosh extract (Chi-Klim drug) and its combination with beta-alanine (Chi-Klim Alanine) for the treatment of menopausal symptoms in women in the early and late postmenopausal women. Materials and methods. A pilot randomized clinical trial included 60 patients aged 40 to 65 years with a duration of menopause not less than 12 months and with a frequency of vasomotor manifestations (tidal) not less than 10 per day. The study did not include women who received menopausal hormone therapy or alternative methods of therapy for the past 3 months. Results. The therapy there was a significant reduction in the severity of menopausal manifestations in both treatment groups, however, in the group 2 the decline was more effective. Acceptance of the drug based on the extract of black cohosh in combination with a dietary supplement on the basis of beta-alanine was 2 times more effective than monotherapy with black cohosh reduced hot flushes per day and had a more pronounced adjoint positive effect on the psycho-emotional symptoms.

РОССИЙСКИЙ ВЕСТНИК АКУШЕРА-ГИНЕКОЛОГА 6, 2017 © Коллектив авторов, 2017 Одной из актуальных проблем в гинекологии, резко снижающей качество жизни у женщин в климактерии, является синдром вульвовагинальной атрофии (ВВА). В отличие от вазомоторных симптомов, которые проходят со временем, симптомы ВВА, как правило, возникают в перименопаузе и прогрессируют в постменопаузальном периоде, приводя к функциональным и анатомическим изменениям [1]. У 15% женщин в перименопаузе и 40—57% женщин в постменопаузе отмечаются симптомы ВВА, такие как сухость влагалища (27—55%), жжение и зуд (18%), диспареуния (33—41%), а также повышенная восприимчивость к инфекционным заболеваниям органов малого таза 6—8%, что значительно ухудшает состояние здоровья, негативно влияет на общее и сексуальное качество жизни [1—3]. У 41% женщин в возрасте 50—79 лет есть хотя бы один из симптомов ВВА [4]. Слизистая оболочка влагалища состоит из четырех основных слоев эпителиальных клеток: базального, парабазального (или митотически активного), промежуточно-

The relevance of urogenital disorders will steadily increase. In recent years the problem of urination disorders on attention. The most common and difficult in terms of treatment is imperative (urgent) form of incontinence as part of overactive bladder (OAB) syndrom. The article presents the results of clinical trials on the effectiveness of combination therapy (tolterodine and topical forms of estriol) compared with monotherapy of m-cholinergic antagonists (tolterodine) in peri- and postmenopausal women with OAB. The study confirmed that local forms of hormone replacement therapy for peri- and postmenopausal women with OAB increases the efficacy of m-cholinoblokers.

РОССИЙСКИЙ ВЕСТНИК АКУШЕРА-ГИНЕКОЛОГА 3, 2015 © Коллектив авторов, 2015 Пероральные формы препаратов для заместительной гормональной терапии негативно воздействуют на течение стрессового недержания мочи и увеличивают риск его развития de novo. Вагинальные формы эстрогенов оказывают терапевтический эффект на все симптомы гиперактивного мочевого пузыря (ГМП), включая ургентное недержание мочи. Менопауза — универсальный физиологический процесс, связанный с падением секреции овариальных гормонов (эстрогены, прогестерон). Диагноз «менопауза» правомочен в отсутствие менструации в течение 12 мес у женщин в возрасте 47—51 года [1]. Время наступления менопаузы зависит от многих факторов, таких как социальный статус женщины, характер питания, образ жизни (курение) и масса тела. Помимо климактерического синдрома, характеризующегося вазомоторными нарушениями, падение уровня половых стероидов служит причиной возникновения урогенитальных расстройств, включающих различные виды недержания мочи. Урогенитальные расстройства — комплекс вагинальных и мочевых симптомов, связанных с развитием атрофических и дистрофических процессов в эстрогензависимых тканях и структурах нижней трети мочеполового

Present-day studies aim to elucidate the role of noninvasive biomarkers in diagnosing the symptoms of overactive bladder, in evaluating the efficiency of its treatment, and in predicting the outcome of the disease. In view of scanty evidence for the diagnostic and prognostic value of determining urinary prostaglandins and cytokines in the presence of overactive bladder symptoms, the expediency in the routine identification of the above markers is a prerogative of the future. It is worth measuring the urinary level of neurotrophin, a nerve growth factor, as a biomarker for the diagnosis of overactive bladder and the evaluation of the efficiency of treatment in patients with this abnormality. The level of brain-derived neurotrophic factor should be considered as a potential biomarker for overactive bladder symptoms, which needs to be further confirmed. It is unreasonable to estimate the urinary level of C-reactive protein as a biomarker for overactive bladder. Thus, the clinical significance of urinary or serum biological substances, that may serve as specific biomarkers for overactive bladder, has not been fully determined so far. The authors declare no conflicts of interest.