Endothelial function is an essential component of providing homeostasis, which allows controlling the state of the vascular bed and ensuring blood supply to organs both under physiological conditions and under the influence of various damaging factors. Endothelial dysfunction is associated with a wide range of pathological conditions and diseases, in the pathogenesis of which the vascular link is involved. Understanding the unifying role of endothelial dysfunction in the pathology of different fields of medicine allows, firstly, to predict the development of serious socially significant diseases, such as cardiovascular diseases, which remain the main cause of death among women. In particular, over the past decade, several cardiovascular risk factors specific to the female population have been identified, such as hypertensive pregnancy complications and menopausal vasomotor symptoms, which, in turn, are caused by endothelial dysfunction. Secondly, timely treatment of endotheliosis suspends or completely prevents both transient disorders associated with endothelial dysfunction and their serious consequences. In this regard, the drug group of glycosaminoglycans and its representative sulodexide are of interest.

The article highlights the pathogenetic mechanisms of endothelial dysfunction formation and its role in the occurrence of gestational complications. The main tasks of the pregravid preparation of patients with diseases associated with endothelial dysfunction are considered. The relevance of early detection of risk factors for gestational complications caused by endothelial dysfunction is emphasized, and methods for its indirect assessment are described. A list of measures aimed at preventing the clinical implementation of endothelial dysfunction is given, and the possibilities of its therapeutic correction are described.

The review of the literature presents data on the possible risks of using combined hormonal contraception and the possibilities of prescribing purely progestogenic contraception as an alternative to the use of combined means. Progestogen contraceptives include a group of agents with different routes of administration, doses and characteristics of progestins, which have a number of differences in the ratio of benefits and risks, availability, reversibility and other properties of contraception. Particular attention is paid to purely progestogenic tablets containing desogestrel, as a means equivalent in effectiveness to combination contraceptives, but safer. Safety issues are considered in the context of the use of breastfeeding women, as well as from the standpoint of the risk of arterial and venous thrombosis. The issues of non-contraceptive positive effects of purely progestogenic contraceptives are covered.

Menstrual rhythm disorders and symptoms associated with the menstrual cycle are one of the main reasons for women to make an appointment with a gynecologist. After the endocrinopathies and organic substrates of menstrual irregularities are excluded, the doctor is faced with the difficult task to treat conditions that reflect the functional dysfunction of the body and its adaptation to high stress load. It is beyond argument that hormone therapy is the main resource of a gynecologist, but it is not always acceptable and does not solve all the problems of normalizing psychoneuroendocrine status. The dependence of functional disorders on environmental stress factors allows a doctor to use lifestyle correction, including rational nutrition and adding various micronutrients, in a program to improve the quality of life, eliminate psychoemotional symptoms and symptoms of autonomic dysfunction. In turn, the restoration of the adaptive reserve of the body becomes key to the recovery of menstrual function.

Pelvic pain is one of the common causes for visiting a doctor, which can be the main symptom of gynecological diseases and an independent pathological condition. Acute pelvic pain is most often caused by an infection that affects the organs of a woman’s reproductive system. Non-infectious causes of pain are also associated with inflammation, and estrogens support pain and inflammation in women, which increases the risk of chronic pelvic pain (CPP). The urgency of the pelvic pain problem is considered not only in connection with an adequate diagnosis of its causes, but also from the perspective of managing the pain symptoms themselves. The anaesthesia strategy significantly improves the quality of life and prevents the development of chronic inflammatory diseases and CPP syndrome. Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in pain therapy, and their effect consists in reducing the synthesis of prostaglandins and is pathogenetically substantiated both in the complex treatment of acute pelvic infections and in the treatment of idiopathic menstrual pain. The article presents clinical observations of the use of NSAIDs with the specified purpose.

Contraception is a unique tool that helps not only to avoid unwanted pregnancy and its termination, but also to get additional health benefits. However, the prevalence of the use of contraceptives as a whole and the resource itself, in terms of additional benefits, hormonal contraception, is far from the actual needs. The presented review substantiates the algorithm for the individual selection of a hormonal drug depending on the clinical portrait of a woman in order to solve the problem of reliable and safe protection from pregnancy with preventive and therapeutic effects.

Endometriosis is a chronic disease with a pronounced psychosomatic component. Women with endometriosis have their own characteristic portrait. The article discusses modern ideas about endometriosis as a factor affecting a woman’s personality, her family relationships, the quality of her sleep, and, finally, communication with a doctor. The approaches to building a productive dialogue with patients with endometriosis, methods of increasing adherence to therapy, the advantages of oral contraception with dienogest in the treatment of endometriosis are examined in detail.

Combined oral contraceptives (COCs) are a highly effective method for preventing unintended pregnancy, but unfortunately, the resource of their contraceptive and therapeutic potential is not used enough, and global unintended pregnancies account for about 40%. The reasons for the lack of proper distribution of COCs are insufficient awareness of the beneficial properties of contraception, along with exaggerated fears of the adverse effects of hormone intake both among women and among doctors. This problem can only be overcome by providing adequate information to health professionals regarding the accumulated data and bringing this information to potential users. The review examines the risks of possible complications, as well as the preventive and therapeutic benefits of some COCs. The COC group is represented by preparations, which properties may differ significantly due to the different dose of the estrogen component and the qualitative characteristics of the progestins. Despite the launch of new combination drugs, COCs deserve high attention. Their efficacy and safety is confirmed by the long practical administration.

Hormonal contraception is a highly effective means of protecting against unwanted pregnancy and has been widely used throughout the world for more than 50 years. Unfortunately, in Russia, women still do not often use hormonal contraceptives as residents of Europe, North and South America. One of the reasons for the lack of proper distribution of hormonal contraceptives in our country remains insufficient awareness of the useful properties of contraception, along with an exaggerated view of the negative consequences of taking hormones, as well as a lack of time for the medical worker to provide adequate counseling. To overcome this problem, it is necessary to create easy-to-use algorithms of the practitioner's actions that help to simplify and optimize the choice of hormonal contraceptive for each specific woman depending on her health status, reproductive status and age. This publication contains an example of such an algorithm, including options for prescribing oral contraceptive drugs for different groups of women.

Abnormal uterine bleeding (AMC) is a common pathology in women of childbearing age. The review gives the current classification and terminology of AMC, the main causes and mechanisms involved in bleeding. Hormonal contraception has been successfully used to control the menstrual cycle in sexually active women. The article is intended to provide research data on the use of hormonal contraceptives, assess the use of hormonal contraceptives in AMC therapy caused by various diseases, and describe the characteristics of evidence-based hormonal contraceptives to be used by women with AMC of various origins who need protection against unwanted pregnancy.

Adipose tissue fulfills different functions, related to homeostasis, consequently, excess of adipose tissue may have a negative influence on endocrine and metabolic parameters. The relationship of separate components of metabolic disorders with reproductive disturbance remains under-investigated. Notably, the role of dyslipidemia (DL) as an independent risk factor of menstrual function and fertility disorders remains unknown. Objective. To evaluate fertility and menstrual disturbance in women with obesity and/or DL. Patients and methods. 150 women aged 18-37 years were divided into 3 groups: 1st - 50 women with body mass index (BMI)>24.9 kg/m2 and DL, 2nd - 46 women with BMI>24.9 kg/m2 and normal blood lipids; 3rd - 54 women with BMI

Chronic endometritis is one of the most urgent problems of modern gynecology. The difficulties of verification, the lack of unity in the understanding of the nature of the inflammatory lesions of the endometrium, a symptomically uneven picture with multiple negative outcomes for reproduction - all this determines the interest in the pathogenesis, diagnosis and treatment of chronic endometritis. The treatment of endometritis, as a form of inflammatory diseases of the pelvic organs, lies in the use of antibiotic therapy. However, the formation of chronic inflammation is associated not so much with the virulence of the organism, but with the features of the immune response of host and the local immunity of the endometrium. This justifies the use in the treatment of immunomodulatory drugs and drugs with proteolytic action, aimed at preventing fibrosis and sclerosis of tissues. One of these drugs is bovhyaluronidase azoximer (Longidaze).

Despite the fact that the study of uterine fibroids has been widely discussed, the problem still remains unsolved. Uterine fibroids are the most common benign neoplasm of female genital system. Increasingly diagnosed in recent decades, uterine fibroids in women planning a pregnancy, which is associated primarily with the social factor: modern women tend to postpone the time of childbirth until a stable material and social status, which often occurs close to the late reproductive age, when the prevalence of uterine fibroids naturally increases. The link between uterine fibroids and fertility disorders ambiguous, but, without a doubt, the presence of uterine fibroids should be taken into account in women with infertility and habitual miscarriage. The optimal solution, but today, in addition to surgical treatment task of restoring fertility in women with uterine fibroids do not exist, there is a possibility of conservative management of these patients. Advantages and disadvantages of surgical and conservative tactics restore fertility in patients with uterine myoma should undergo evaluation and further development.

Воспалительные заболевания органов малого таза (ВЗОМТ) широко распространены в популяции женщин репродуктивного возраста. Особые свойства возбудителей урогенитальных инфекций, дисфункция иммунной системы макроорганизма часто приводят к формированию хронического воспаления, прежде всего у женщин с бессимптомным течением инфекций, передаваемых половым путем (ИППП), и пациенток с субклиническими формами ВЗОМТ. Хронические ВЗОМТ в свою очередь сопряжены с многочисленными расстройствами репродуктивной сферы, включая бесплодие, невынашивание беременности, хроническую тазовую боль. Профилактика хронического воспаления и его негативных последствий заключается в раннем выявлении и адекватном лечении как ИППП, так и ВЗОМТ, особенно их субклинических вариантов. К сожалению, антибиотикотерапия не всегда оправдывает возлагаемые на нее надежды, отчасти ввиду повышающейся резистентности возбудителей, отчасти из-за собственных побочных эффектов, в том числе иммуносупрессивного действия. Для оптимизации антибиотикотерапии и предупреждения развития ВЗОМТ и их рецидивов в схемы лечения могут вводиться иммуномодуляторы. Поскольку ключевую роль в иммунном ответе на инфекционное внедрение играет фагоцитарное звено, включение в терапию азоксимера бромида, обеспечивающего полноценную функцию фагоцитов, представляется обоснованным и целесообразным.

The attitude of obstetricians-gynecologists to intrauterine hematoma has undergone a serious metamorphosis over the past 15–20 years. The first systematic surveys did not detect a risk of hemorrhage for a future pregnancy, if the embryo/fetus «survived» the threat of rejection. At the same time, the importance of exogenous causes of threatened miscarriage was exaggerated to the detriment of understanding of the endogenous processes that lead to disturbances of hormonal-immune interaction and dialogue between the mother and the fetus. As far as accumulation of evidence of late gestational complications the hollowness of well-being in pregnancy after intrauterine resolution of hematomas became apparent. Retrochorial hematomas that occurred in the first trimester of pregnancy are of particular importance. Today no one doubts that threatened miscarriage, the essence of which is detachment of the chorion, must be treated not by bed rest and antispasmodics, but by applying means acting on the universal reason of the gestational sac rejection – progestogens.

Pelvic inflammatory diseases (PID) are widespread in the population of women of reproductive age. The special properties of pathogens of urogenital infections, immune dysfunction of host systems often lead to the formation of chronic inflammation, especially in women with asymptomatic infection infections, sexually transmitted infections, and patients with subclinical PID. Chronic pelvic inflammatory disease, in turn, are associated with numerous disorders reproductive system, including infertility, miscarriage, chronic pelvic pain. Prevention of chronic inflammation and its negative consequences is early detection and adequate treatment as STDs and PID, especially their subclinical variants. Unfortunately, antibiotics do not always justify the hopes placed in it, partly because of rising resistance of pathogens, in part due to their own side effects, including an immunosuppressive action. To optimize antibiotic therapy and prevention of pelvic inflammatory disease and relapse in the treatment regimen immunomodulators may be used. Since a key role in the immune response to infectious implementation is played by phagocytic link, inclusion in therapy azoximer bromide, providing a full function of phagocytes, seems reasonable and appropriate.

Due to the associated serious endocrine and metabolic disorders, hyperandrogenic conditions result in skin lesions and deterioration of the quality of life. The present study aimed to evaluate androgen-dependent dermopathy in patients with various clinical status and determine the effectiveness of therapeutic interventions. The study included 82 patients with ADP who underwent a comprehensive examination with the participation of a dermatologist. The patients underwent general and gynecological examination; dermatologist's examination using ultrasound; skin microtopography; blood tests for the level of peptide and steroid hormones; biochemical blood test to evaluate carbohydrate and fat metabolism. Differentiated treatment was assigned based on the data obtained from the survey: patients with irregular menstrual cycle received COCs containing drospirenone (all women were in need of contraception); for overweight or obese women, the therapy was complemented with metformin; patients with regular ovulatory cycles received flutamide. The treatment demonstrated high efficacy against androgen-dependent dermopathy and safety for the metabolic status.

Vitamins and minerals are essential for normal conception, pregnancy, fetal and child's development. Widespread micronutrient deficiency in the modern population adversely affects the health of both mothers and children. The use of vitamins and minerals in step pregravidal preparation and during pregnancy is an important factor in the prevention of miscarriage, premature delivery, impaired function of the fetoplacental complex, fetal malformations and weight lacking infants or immature ones, and, the best way to introduce the necessary micronutrients is the use of vitamin-mineral complexes .Vitamin and mineral complexes have obvious advantages in comparison with a subsidy of some micronutrients in pregnant women. The review highlights the role of vitamins and minerals in a successful pregnancy and justified their prophylactic use.

The review examines the problem of increase of liver transaminases in the second half of pregnancy. ALT and AST reflect processes of hepatocyte injury, but are not specific for the diagnosis of a particular disease of the liver. However, determining the cause of changes of liver samples in a short time in pregnant women is extremely important because of the significant differences in prognosis for the mother and the fetus, and the tactics of treatment and management of patients. Authorspresent algorithm of differential diagnosis of obstetric and non-obstetric causes of enlarged alanine aminotransferase and aspartate aminotransferase in the later stages of gestation.