Individual sexual and reproductive life management has been сonfirmed by medical and state communities since 1990s. Every citizen officially received rights for access to appropriate goods and services. Such international agreements as 1994 International Conference on Population and Development (ICPD, Cairo, Egypt) and 2004 WHO Reproductive health strategy, estimated reproductive health and family planning as priorities. Worldwide agreement on the 2005 summit declares achieving of female reproductive health before year 2015 as worldwide progress.WHO created complex of international eligibility criteria for male and female contraception with the aim of medical aid improvement. According to WHO plan, those criteria should be used by countries considering policy, needs, priorities and resources of national healthcare programs. For example, USA, United Kingdom, Russia etc. have successfully adopted medical eligibility criteria for contraception on the national level.The present review is summary product created by interdisciplinary expert group including representers of federal and regional healthcare establishments, medical universities, and international medical organizations.

Today, the contribution of the microbiota to the genesis of many diseases, including endometriosis, is widely discussed. However, the literature data on the microbiological composition of endometriosis are contradictory. In addition, data indicating the effect of conservative therapy on the microbiological composition are limited only to estrogen-containing drugs, while there is no data on the effect of progestogens. Objective: to evaluate the composition of the intestinal microbiota of patients with external genital endometriosis on oral progestogen therapy. A single-stage pilot study was conducted, which included 17 patients with external genital endometriosis (average age 30.9 (7.8) years, average body mass index 20.2 (2.0) kg/m 2 ). The women received oral progestogen therapy (dienogest at a dose of 2 mg per day in a continuous mode). Microbiological examination of faecal samples by culturomics methods with inoculation on selective and non-selective nutrient media, followed by species identification of microorganisms, was carried out using time-of-flight mass spectrometry (MALDI-TOF MS) at two points: initially and after 6 months of taking dienogest. Dienogest therapy showed an improvement in a number of microbiological indicators of the intestinal microbiota in the form of a tendency to increase species and taxonomic diversity, a decrease in the Bacillota / Bacteroidota index, and a decrease in the titer of conditionally pathogenic microorganisms Staphylococcus spp. and increased colonization of symbiotic bacteria of the Collinsella aerofaciens and Lactobacillus spp. Thus, dienogest therapy can have both a direct and indirect effect on the composition of the intestinal microbiota of patients with external genital endometriosis, which was demonstrated by the results of the study.

Introduction. Accuracy of transvaginal sonography (TVS) is substantial as the first-line approach of intrauterine pathology diagnostics. However, TVS has some limitations and factors that reduce its accuracy have not been definitively determined.Aim. To evaluate the diagnostic accuracy of echography in intrauterine pathology and identify factors affecting it. Materials and methods. The study included 250 women who underwent hysteroscopy with endometrial biopsy: 128 with endometrial polyps (EP), 33 with endometrial hyperplasia (EH), 28 with chronic endometritis (CE) and 60 women without endometrial pathology.Results. The sensitivity and specificity of ultrasound in diagnosis of EP was 64.8% and 77.9%, respectively, EH – 64.7% and 89.8%, CE – 39.3% and 90.1%. Cumulative intrauterine pathology’s sensitivity reached 94.7%, and the specificity – 15.0%, which indicates a significant amount of false positive results. The lowest accuracy was in CE, EP less than 0.6 cm and in the absence of abnormal uterine bleeding.Conclusions. TVS has limitations in verifying a specific diagnosis and characterized by both hyper- and hypodiagnosis. The clinician should take into account the size of the EP and the presence of symptoms for choosing optimal management.

Insulin resistance is the main pathogenetic component of many metabolic diseases, including obesity, type 2 diabetes mellitus, gestational diabetes mellitus, and polycystic ovary syndrome (PCOS). Despite the fact that to date the mechanisms of insulin resistance formation have not been established, one of the promising directions at present is the search for potential therapeutic strategies for its correction, due to the fact that this also improves the course of the concomitant underlying disease. Insulin sensitizers are a generally recognized method of PCOS therapy due to their safety and effectiveness in normalizing the metabolic and endocrine profile of patients with polycystic ovary syndrome. The leading position in this direction is occupied by the combination of myo-inositol (MI) with D-chiro-inositol (DHI) in a ratio of 40:1, which, according to the conducted studies, is comparable to the concentration of inositols in the blood plasma of healthy women. This ratio of MI/DHI is effective both for normalization of the metabolic profile, and for regulation of the menstrual cycle and overcoming anovulatory infertility. An analysis of the literature has shown that a number of biologically active substances, such as folic acid, vitamin D and alpha-lipoic acid, in combination with insulin sensitizers, have additional advantages, which gives grounds for continuing research on their significance as components of combined treatment, as well as in the search for the optimal dose and duration of such therapy.

Long-acting reversible contraception (LARC) is recognized as a highly effective and convenient method for preventing unwanted pregnancy. However, in real clinical practice, the level of implementation of LARC remains relatively low, which, presumably, may be related to misconceptions about their contraceptive efficacy and side effects among health professionals and patients. One method of long-acting reversible contraception is the intrauterine device. Hormone-containing intrauterine systems are recognized as one of the most affordable contraceptive methods, characterized by a very low failure rate (less than 1%), which does not depend on the patient’s compliance. A review of the literature focuses on the efficacy and safety of a low-dose levonorgestrelcontaining intrauterine system containing 19.5 mg of levonorgestrel (LNG-IUD 12). We present data on the advantages of this intrauterine system in comparison with its counterparts. Analysis of the literature has shown that adherence to low-dose contraception is observed among women of reproductive age. The smaller diameter of the guide tube is associated with a more successful and less painful insertion of the device into the uterine cavity. This may be an obvious advantage for young, nulliparous women. In addition, the LNG-IUD has a predominantly local progestogenic effect on the endometrium, so there is a relatively low development of systemic effects. Despite its lower levonorgestrel content, the LNG IUD 12 (Kyleena LNG 19.5 mg, levonorge strel-releasing intrauterine system with an average LNG release of 12 µg/24 h in vivo over the first year of use) has a high level of contraceptive efficacy. Thus, LNG-IUD 12 is associated with a favorable efficacy and safety profile regardless of a woman’s age or parity, which has been confirmed by the results of clinical trials.

Polycystic ovary syndrome (PCOS) is a polygenic endocrine disorder caused by both genetic and epigenetic factors. Depending on the period of a woman's life, the clinical picture, diagnosis, and treatment tactics of the disease are different. PCOS has a complex of reproductive, metabolic and psychological characteristics. The target audience of these clinical recommendations are obstetrician-gynecologists, endocrinologists, general practitioners, general practitioners. In these clinical guidelines, all information is ranked according to the level of persuasiveness of recommendations and the reliability of evidence, depending on the number and quality of studies on this issue.

Migraine is often concurrent with endometriosis; however, the mechanisms of comorbidity of these conditions are inadequately studied. Pain is considered as the most significant clinical symptom and maladaptive manifestation of both migraine and endometriosis. Studying the relationship between the clinical manifestations of pain syndrome in patients with endometriosis and migraine is important, since it will contribute to the understanding of the mechanisms of comorbidity of these diseases.Objective: to analyze the features of pain syndrome in patients with migraine and genital endometriosis to clarify the neurogenic mechanisms of their comorbid relationship.Patients and methods. A total of 125 patients who had gone to a gynecologist for endometriosis were examined for the presence of migraine. In accordance with the inclusion criteria, 79 patients (mean age, 34.68±7.11 years) with genital endometriosis confirmed by diagnostic laparoscopy participated in the further study. Two age-matched groups were formed: a study group consisted of 38 patients with endometriosis and concomitant migraine; a comparison group included 41 patients with endometriosis without migraine. All the patients underwent clinical neurological examination, questionnaire survey, pelvic ultrasound, assessment of the severity of pelvic pain according to the pelvic pain index, and determination of the level of central sensitization (CS) using the CS Inventory.Results and discussion. 42% out of the 125 patients who had visited their gynecologist for endometriosis suffered from concomitant migraine, which confirms the comorbidity of these diseases. Chronic pelvic pain (CPP), dysmenorrhea, dyspareunia, and dyschesia were more common in patients with endometriosis and migraine; there were more patients with asymptomatic endometriosis in the comparison group. The patients of the two groups did not differ in the presentation of different forms of endometriosis, which favors the leading role of central mechanisms in the pathogenesis of pain syndrome in comorbidity of these diseases.In addition, there was a statistically significant increase in the presentation of CPP and dysmenorrhea in patients with chronic migraine compared to those with episodic migraine and to those without migraine. Significantly higher levels of CS according to CSI and pelvic pain index were found in patients with chronic migraine and endometriosis, which suggests that CS plays a key role in the comorbidity of these diseases.Conclusion. The phenomenon of CS is one of the mechanisms of comorbidity of migraine and endometriosis, contributes to both the worsening of various painful manifestations of endometriosis and the increase in migraine attacks, thereby causing obvious maladaptation in patients. The role of CS in the comorbidity of migraine and endometriosis opens up possibilities for the elaboration of a comprehensive interdisciplinary approach to treating these diseases.