Background. Bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC) are common conditions that significantly impact the quality of life for women of reproductive age. Although standard treatments for BV and VVC are effective at alleviating acute symptoms, they often fail to restore the vaginal microbiota in the long term. Aim. To evaluate the efficacy and safety of oral multiprobiotics as part of the comprehensive therapy for BV and VVC. Materials and methods. A prospective, randomized, double-blind, placebo-controlled, parallel study was conducted involving 180 patients of reproductive age. The cohort comprised 90 individuals with confirmed BV and 90 with VVC. Patients were randomized into four groups: BV with probiotic (n = 50), BV with placebo (n = 40), VVC with probiotic (n = 50), and VVC with placebo (n = 40). The investigational agent was a multiprobiotic formulation containing Lactobacillus rhamnosus, L. plantarum, L. helveticus, L. gasseri, and L. crispatus. The treatment duration was one month. Parameters assessed included changes in clinical symptoms (using a 10-point scale), vaginal pH, vaginal microflora composition (analyzed via real-time polymerase chain reaction using Femoflor-16), and patient satisfaction with treatment outcomes. Results. The addition of the multiprobiotic from the initiation of standard therapy significantly contributed to the restoration of normal vaginal microbiota composition, evidenced by a substantial increase in the proportion of Lactobacillus spp. (p 0.001), normalization of vaginal pH and more pronounced relief of clinical symptoms compared to placebo (p 0.001), and increased patient satisfaction with the treatment outcomes (p 0.05). Specifically, the increase in Lactobacillus spp. in the BV + probiotic group was 33.3% vs. 14.4% in the placebo group (p 0.001), while in the VVC + probiotic group, it was 19.8% vs. 6.7% (p 0.001). According to Femoflor-16 data, the absolute increase in Lactobacillus spp. concentration in the BV + probiotic group was 1.8 times greater (+3.48lg vs. +1.94lg), and the reduction of BV-associated anaerobes was 1.8–2.3 times more significant than in the placebo group (all p 0.001). For the VVC + probiotic group, the elimination of Candida spp. was 1.4 times more pronounced (-3.86lg vs. -2.72lg; p 0.001), and the increase in lactobacilli was six times greater. Additionally, significant reductions in Staphylococcus spp., Streptococcus spp., and Enterobacteriaceae were documented in the probiotic group, with no similar changes observed in the placebo group. Patients diagnosed with VVC exhibited a significant decrease in pH levels by 0.46 units (p 0.001). Following therapy, the probiotic groups presented statistically significant reductions in clinical symptom severity when compared with the placebo groups (p 0.001). In BV patients, the intensity of abnormal discharge averaged 1.2 ± 0.8 points vs. 2.1 ± 1.2 points, and the unpleasant odor intensity averaged 0.8 ± 0.6 points vs. 1.5 ± 0.9 points. In VVC patients, the severity of itching and burning was recorded at 0.9 ± 0.7 points vs. 1.8 ± 1.1 points. Treatment satisfaction was notably higher in the probiotic groups: 88% vs. 70% for BV (p = 0.034) and 86% vs. 65% for VVC (p = 0.019). Conclusions. The findings of this study support the inclusion of oral multiprobiotics that contain combinations of L. rhamnosus, L. plantarum, L. helveticus, L. gasseri, and L. crispatus in comprehensive treatment regimens from the first day of therapy for BV and VVC, as this approach enhances treatment efficacy and may reduce the risk of relapse.

Obesity represents a global non-infectious pandemic of the 21st century. More than 2 billion people all over the world suffer from obesity and, according to forecasts, the number of such people will increase to almost two thirds of the Earth’s population by the year 2050. In recent years, obesity treatment methods changed dramatically from previous decades. The emergence of incretin-based drugs increased the potential for medical control of body weight and metabolic health in obesity in order to prevent cardiometabolic, carcinogenic, and other complications in the long term. The review considers physiological and pharmacological aspects of incretin therapy for obesity, accessibility and prospects of novel therapeutic combinations, such as dual and triple glucagon-like peptide-1 receptor agonists, with the aim of treatment strategy personalization and individualization.

Postmenopausal atrophic vaginitis is a complex of vulvovaginal, urinary, and sexual symptoms associated with estrogen deficiency. Objective. To expand our understanding of the pathogenesis of postmenopausal atrophic vaginitis. Materials and methods. This prospective study included 51 postmenopausal women diagnosed with N95.2 – Postmenopausal atrophic vaginitis – and 30 postmenopausal women with unverified atrophic vaginitis. All women underwent posterior vaginal wall biopsy using a 3-mm punch. The expression of inflammatory markers (CD-56, CD-4) was assessed using immunohistochemistry. Results. The expression of CD56 in the stroma and epithelium of the vaginal wall in the study group was 0.5±0.28 and 0.84±0.58, respectively (compared to 0.06±0.13 and 0.1±0.04 in the control group; p<0.05), while the expression of CD4 in the stroma and epithelium was 4.5±2.80 and 4.0±2.5, respectively (compared to 0.37±0.33 and 0.36±0.28 in the control group; p<0.05). Conclusion. Vaginal CD56 expression in atrophic vaginitis was 8.3-fold higher in the stroma and 8.4-fold higher in the epithelium compared to the morphological control group. Similarly, CD4 expression was 12.1-fold higher in the stroma and 11.1-fold higher in the epithelium, which indicates persistent abnormal inflammation of the vaginal mucosa in atrophic vaginitis.

Genitourinary syndrome of menopause (GSM) remains an unsolved problem of menopause medicine. There still GSM diagnosis and treatment defects all over the world. In this regard, it is reasonable to use both domestic clinical guidelines and credible foreign guidelines allowing one to structure a counseling model for women suffering from GSM and prescribe personalized treatment. In this paper, management of patients with the verified GSM will be analyzed considering the International Menopause Society guidelines (2025), and personalized management algorithms for women with GSM and associated comorbidities will be provided.

The study investigates the pathogenesis of postmenopausal atrophic vaginitis associated with impaired neoangiogenesis. Special emphasis is given to VEGF-A (endothelial proliferation marker) and CD31 (pro-angiogenic marker) as key drivers of trophic changes in the mucous membrane. Objective. To investigate the role of angiogenic markers in the development of postmenopausal atrophic vaginitis. Materials and methods. The prospective study included 51 postmenopausal women with a diagnosis of N95.2 Postmenopausal atrophic vaginitis and 30 postmenopausal women with unverified atrophic vaginitis. The inclusion criteria for the study were: postmenopausal women with a verified and unverified diagnosis of N95.2, informed consent of the patient for the study. In accordance with the stated goal, the women were divided into 2 groups: 1) postmenopausal women with atrophic vaginitis (n=51); 2) postmenopausal women without atrophic vaginitis (control group n=30). The following parameters were assessed: age, duration of menopause, severity of atrophic vaginitis, as well as changes in the connective tissue and muscular compartments of the vagina using the assessment of vaginal wall remodeling markers (vimentin, desmin) by immunohistochemical analysis. Immunohistochemical analysis was used to assess the expression of angiogenic markers (VEGF-A and CD31). Results. The results of the study demonstrate significant changes in angiogenic markers in cases of atrophic vaginitis. There is a significantly lower expression of markers compared to the control group: VEGF by 1.37-fold and CD31 by 1.97-fold. Conclusion. Significant changes in angiogenic markers within the vaginal wall are observed in atrophic vaginitis. Postmenopausal women with atrophic vaginitis exhibit defective expression of these angiogenic markers.

One of the most controversial issues of modern gynecology is the study of the effect of combined oral contraceptives (COCs) on the endocrine-metabolic profile. Unfortunately, there are still hormonophobic prejudices in society about the adverse impact of COCs on body weight, carbohydrate metabolism, and lipid profile despite no evidence base for such judgments. Therefore, the purpose of the article is to analyze the effect of E4/drospirenone-based COCs on endocrine-metabolic parameters through the lens of evidence-based medicine.

In the 21st century, two medical and demographic trends towards increased life expectancy and higher prevalence of obesity and metabolic syndrome (MS) have formed literally before our eyes. It is metabolic syndrome (often being an essential attribute of obesity) that entails a number of potential risks for not only endocrine and metabolic, but also somatic health. It has been proven that MS is a condition that potentiates the risk of developing a number of disease entities: cardiovascular to neurodegenerative. Furthermore, due to progressive hypoestrogenism, peri- and postmenopause are accompanied by the endocrine and metabolic reprogramming that significantly increases the risk of realization of the above disease entities. Hence, the aim of the paper is to consider the relevance of menopausal metabolic syndrome at present, as well as to cover the features of clinical management of patients in this cohort based on modern evidence-based data.

Background. Pelvic organ prolapse (POP) significantly reduces quality of life, including sexual function. Despite the high prevalence (up to 50% of women over 40 years of age), the effect of POP on intimate health has not been sufficiently studied. Aim. To assess sexual function in women with genital prolapse using a validated FSFI questionnaire. Materials and methods. A prospective comparative study was conducted with 170 females; however, 53% (n = 90) refused to complete the FSFI questionnaire and did not sign the informed consent form. The test group included 40 patients with POP; the control group included 40 females without POP (groups were comparable in age; p 0.05). The prospective sample study is ongoing, and this paper presents interim results. Sexual function was assessed using the FSFI self-administered questionnaire (19 questions, 6 domains). Statistical analysis was performed using SPSS 26.0 and R 4.2.0 (t-test, p 0.05). Results. Total FSFI score in the test group was lower by 11.35 points [19.05 vs. 30.4; 95% confidence interval (CI) (-12.94; -9.76); p 0.05]. Key domain deficits included orgasm (53% decrease [Δ = -2.77, 95% CI (-3.25; -2.29); p 0.05]); pain (44% increase in symptoms [Δ = -2.26; 95% CI (-2.68; -1.84); p 0.05]); lubrication (45% decrease [Δ = -2.19, 95% CI (-2.55; -1.83); p 0.05]), and arousal (48% decrease [Δ = -1.76; 95% CI (-2.10; -1.42); p 0.05]). The following barriers were observed during the study: 68.3% of women with POP refused to be surveyed (the “stigma paradox”). Conclusion. POP is associated with critical impairment of sexual function, especially in the domains of orgasm, pain, arousal, and lubrication. The results of the study justify the need to include the assessment of sexual function in the standard of POP diagnostics, the development of rehabilitation programs that combine surgical correction and restoration of intimate health, and the introduction of anonymous questionnaire methods with the participation of psychologists to overcome stigma.

The relevance of the problem of obesity grows exponentially every year all over the world. Almost a half of the global adult population suffers from overweight or obesity. Today, the fact remains indisputable that obesity provides the basis for realization of a number of somatic polysystemic disease entities, including gynecological and carcinogenic ones. At the same time, the most strong is the correlation between overweight/obesity and proliferative diseases of the endometrium, such as endometrial hyperplasia and endometrial cancer. The prevalence rates of these disease entities continue to grow every year representing a “specular reflection” of global unfavorable changes/trends. The paper is aimed to assess current epidemiological situation for obesity and proliferative diseases of the endometrium, disclose the key pathogenetic links of those, and cover modern management of these disease entities involving the use of unique, innovative, complex solutions, including pharmacological ones.

Endometriosis still remains one of the most interesting but poorly understood disease entities in the world. The current epidemiological research data demonstrate that the endometriosis incidence rate will soon become somewhat of a pandemic and will affect up to 1 billion of fertile age women on the globe. At the same time, one of the main problems of endometriosis at present is underestimation of the endometriosis-associated atypical conditions and comorbidities. In this regard, it is important to consider modern, proven nosological associations of endometriosis with other comorbidities and atypical algological symptoms, as well as to note modern strategies for the effective and pathogenetically substantiated disease therapy.

A progressive increase in the prevalence of female obesity is reported year by year. It is a well known and proven fact that obesity is the basis for realization of a number of somatic disease entities (cardiovascular to neurodegenerative), but for some reason the effects of obesity on the reproductive health often go underreported. The fact remains dogmatically proven that obesity negatively affects the women’s reproductive potential and obstetric outcomes (both antenatal and intranatal). The review covers global aspects of the issue of obesity, the search for pathogenetic interplay between those, and the management algorithm for women with verified obesity and the associated reproductive disorders based on the current guidelines.

The world’s public health community accepts obesity as a global carcinogenic crisis, since it considerably increases the likelihood of developing various cancer types, including, for example, breast cancer, colon cancer, and ovarian cancer. This review considers a complex interplay between obesity and carcinogenesis, cancer progression; the cellular and molecular mechanisms are described in detail. Chronic systemic inflammation associated with high expression of pro-inflammatory adipocytokines by the visceral adipose tissue that leads to epigenetic stress and gene-stress and, as a result, to metabolic disorders, is a key carcinogenesis trigger. The above abnormal inflammation creates a favorable environment for cancer development, affecting the immune cells, adipocytes, and gut microbiota.

Obesity remains the most pressing unresolved issue of modern medicine. The global population of individuals suffering from obesity, that not only considerably reduces their quality of life, but often leads to disability, increases every year. Moreover, the attitude of modern medicine is as follows: obesity provides the basis for realization of the incidence of polysystemic somatic disorders and cancer, including gynecological disease entities (among which the most strongly associated ones are endometrial hyperplasia and cancer). In this regard, the development of unique promising metabolism-modifying methods of target drug therapy for obesity, which will not only allow one to achieve target body mass index values, but also prevent long-term effects on female health, is most relevant. Tirzepatide, designed for drug treatment of obesity and diabetes mellitus and recently registered in the RF, represents one innovative drug, the key features of which are considered in this paper.

Aim. To assess efficacy and safety of using bovhyaluronidase azoximer (BA) 3000 IU for therapy of chronic endometritis (CE) in patients with the uterine factor infertility. Methods. The data of the open-label independent comparative randomized clinical trial involving 160 women with CE and infertility were analyzed. Patients were divided into two cohorts, 80 individuals each, depending on the presence (I+) or absence (I-) of a proven/significant intrauterine infection. All the participants were through the physical therapy (PT) course; patients with the proven/significant causative contagium present in the uterine cavity received antimicrobial therapy (АМТ). Patients were further randomized within the cohorts at a ratio of 1:1 to receive or not receive BA. Results. The decrease in the CD138+ plasma cell counts was reported for all groups, but basic therapy supplementation with BA ensured the significantly high therapy efficacy: in the I+ cohort, there were no CD138+ plasma cells in 77.5% of patients vs. 2.5% in the control group (p<0.001), while in the I- cohort there were no CD138+ plasma cells in 30% vs. 0% (p<0.001). The combination therapy involving the use of BA significantly decreased the dysmenorrhea severity, improved the CE hysteroscopic and morphological patterns. This is suggested by the significantly decreased intensity of lymphoid infiltration and focal fibrosis of the endometrial stroma, regulation of the immunohostochemistry marker (CD138, CD20, CD56, VEGF, tumor necrosis factor α, MUC1) expression, and the increased blood flow based on the Doppler data (p<0.001). No adverse events, including allergy associated with the use of BA, were recorded during the trial. Conclusion. High efficacy and safety of bovhyaluronidase azoximer in combination therapy of CE were determined.

Objective. To assess the quality of sexual function in patients suffering from genitourinary menopausal syndrome. Materials and methods. The prospective study included 51 postmenopausal women with a verified diagnosis of N95.2 Postmenopausal atrophic vaginitis and 30 postmenopausal women without a verified diagnosis of N95.2 as a control group. The inclusion criteria for the study were: postmenopausal women with a verified diagnosis of N95.2, regular sexual activity at least once a week, informed consent of the patient for the study. The following parameters were assessed: average age of the participants, presence of vaginal, urinary and sexual complaints (dyspareunia, dysorgasmia, decreased libido, postcoital bleeding), female sexuality index. Results. The results of the study demonstrate that women suffering from symptoms of genitourinary menopausal syndrome have a low quality of sexual life. Each patient registered at least one complaint associated with sexual dysfunction. Significantly more often a decrease in libido is recorded, which occurs in 58.8% of cases, dyspareunia – in 39.2% of women, postcoital bloody discharge was noted by 27.4% of respondents. The index of female sexuality was 17.2±5.2, which is 2 times lower compared to the indicator in the control group – 34.4±2.4. Conclusion. Genitourinary postmenopausal syndrome has a negative impact on the quality of sexual life, leading to decreased libido, dyspareunia, postcoital bleeding and, as a consequence, leads to decreased satisfaction with sexual life up to the refusal of sexual intercourse.

Epidemiological data of the recent years further suggest progressive aging of the world’s population. Today, given high life expectancy and the average age of menopause, a woman will be postmenopausal for at least 40% of her entire life. In this regard, the issue of clinical management of this cohort becomes more and more relevant for modern gynecology. At the same time, genitourinary syndrome of menopause (GSM), that totally and progressively reduces the woman’s quality of life, represents one of the most prevalent menopausal disorders. The review considers “classical” approaches and promising techniques, such as remodeling laser therapy, in management of such disorders.

Pelvic organ prolapse (POP) has a considerable negative effect on the women’s quality of life. The rate of POP will grow due to population ageing (according to forecasts, by 46% by the year 2050). The global prevalence of obesity is increasing dramatically: according to the WHO forecasts, more than 50% of the Earth’s population (more than 4 billion people) will be overweight or obese by the year 2035. Obesity and dyslipidemia (elevated levels of triglycerides, low-density lipoprotein cholesterol; decreased levels of high-density lipoproteins) can trigger the development and progression of POP. However, this aspect of the POP pathogenesis is poorly understood. Aim: to expand the knowledge about the POP pathogenesis in patients with obesity and metabolic disorders. Methods. Analysis of the results of the studies published in the CochraneLibrary, PubMed, Science Direct, ELibrary digital libraries in 2010–2024 for the keywords “pelvic organ prolapse/пролапс тазовых органов”, “recurrence/рецидив”, “pathogenesis/патогенез”, “metabolic syndrome/метаболический синдром”, “abdominal obesity/абдоминальное ожирение”, “hypertriglyceridemia/гипертриглицеридемия”, “hypercholesterolemia/гиперхолестеринемия” was performed. Results. Coupled with the mechanical load caused by abdominal obesity, chronic systemic inflammation associated with metabolic syndrome, elevated levels of pro-inflammatory cytokines and activation of matrix metalloproteinases, as well as oxidative stress can result in weakening of the pelvic organ supportive structures, and microvascular dysfunction disturbes local hemodynamics, thereby contributing to the pelvic floor connective tissue remodeling processes. Conclusion. Qualitative studies involving large samples are necessary for better understanding of the pathogenetic mechanisms underlying the development of primary POP and POP recurrence, as well as for the development of the treatment approaches contributing to reducing the risk of progression. The management tactics for patients with POP associated with metabolic syndrome requires a multidisciplinary approach.

High rate of recurrence after surgical correction remains the key problem of the pelvic organ prolapse (POP) treatment, while the key objective is the search for the ways to improve surgical techniques. Various surgical approaches, including minimally invasive, involving the use of mesh implants or native tissues have been developed, but neither patients, nor surgeons are satisfied with the results. Aim: to analyze available scientific data on the efficacy and safety of surgical correction methods in terms of genital prolapse recurrence. Methods. Analysis of scientific papers published in the ELibrary, PubMed, CochraneLibrary, Science Direct databases in 2010–2024 for the keywords “pelvic organ prolapse/пролапс тазовых органов”, “rectocele/ректоцеле”, “cystocele/цистоцеле”, “apical prolapse/апикальный пролапс”, “recurrence/рецидив”, “surgical treatment/оперативное лечение” was performed. Results. To date, no perfect surgical approach to treatment of POP has been developed; no optimal surgical procedures for correction of primary and recurrent POP allowing one to avoid the disease progression have been proposed. A comprehensive personalized approach based on thorough assessment of the pelvic floor condition taking into account all the existing risk factors of primary POP or new disease progression factors in case of recurrence is the key to reducing the POP recurrence rate. Conclusion. Verification of fascial defects during preoperative and intraoperative periods is believed to be critical for improvement of the POP surgical treatment outcomes. Sufficient extent of surgical intervention, elimination of all fascial defects, optimal use of MESH technologies might improve anatomical and subjective operative results, as well as reduce the risk of recurrence. The use of synthetic implants in a number of studies has proven to be effective, regardless of the ongoing discussions about safety of such methods. It is necessary to continue the research on a large sample, since it will make it possible to improve the long-term treatment outcomes.

Until recently, it was difficult to discuss such a narrow, complex problem associated with the physiological/lactation amenorrhea due to terminological defects and the lack of appropriate attention to the problem from both medical science and clinicians. Today, genitourinary syndrome of lactation (GSL) is a frequently used term reflecting the symptoms of vulvovaginal atrophy against the background of the decline in the quality of life in women during lactation. The review covers the issues of GSL, from pathogenesis to the principles of therapy.