Early Reproductive Age Research Articles

Acupuncture improves neuroendocrine defects in a preclinical rat model of reproductive aging

AimsClinical data supports electroacupuncture (EA) as an effective treatment for female reproductive disorders especially gonadotropin abnormalities. This study aims to detect the mechanism of EA that improves the neuroendocrine defects particularly the luteinizing hormone (LH) surge failure in early reproductive aging females. Materials and methodsMiddle-aged ovariectomized rats primed with hormone were treated by EA at acupoints CV4 and SP6 and undergone LH assay. Morphological experiments detected the activation of Kiss1 cells in the anteroventral periventricular nucleus (AVPV). Using targeted liquid chromatography with tandem mass spectrometry (LC-MS/MS) and RNA-sequencing, we determined the concentrations of neurotransmitter metabolites and transcriptomics in AVPV. Key findingsEA significantly increased c-Fos and c-Fos-positive Kiss1 cells in the middle-aged AVPV as well as the total and peak LH release. Targeted LC-MS/MS and RNA-sequencing of AVPV identified differential neurotransmitters in the middle-aged females including Acetylcholine chloride, 5-Hydroxyindole-3-aceticacid, Kynurenine, Histamine, L-Histidine and L-Glycine, while EA decreased the concentration of Acetylcholine chloride. Totally 1255 differentially expressed genes modulated by EA were strongly implicated in neurotransmitter transport and KEGG pathways involved neuroactive ligand-receptor interaction, glutamatergic and gamma-aminobutyric acid-mediated synapse. Specifically, the mRNAs associated with the LH surge such as hormone receptor Pgr, adrenoceptor Adra1a, neurotransmitter transporters Slc17a6 and Slc32a1, glutamate decarboxylase Gad2 and Kiss1 were markedly altered by EA. SignificanceThese findings showed that the age-related reduction of LH surge occurred via differential neurotransmitter metabolisms and altered transcriptions in AVPV, which proposed EA-based therapy for improving responsiveness of the hypothalamus to hormone in women with advanced age.

Study of risk factors for insulin resistance in women with a burdened metabolic history

Insulin Resistance (IR) is a state of insufficient biological response of the body's cells to insulin, which leads to further disruption of carbohydrate metabolism and increased blood glucose levels. Early detection of IR risk factors improves the prognosis and prevention of severe metabolic syndrome, preservation and restoration of women's reproductive potential, and becomes the foundation for the health of the future generation. Aim of the study was the influence of potential risk factors on the development of latent IR manifestations 82 women of early reproductive age who signed an informed consent for the study were examined. A specially designed questionnaire was used for the study, and anthropometric parameters and laboratory data (including insulin, glucose tolerance test), and calculation of indices (HOMA-IR (Homeostasis Model Assessment of Insulin Resistance) and Matsuda). According to the results of the study, in accordance with the indicators of Relative Risk (RR) and Odds Ratio (OR), we consider the following potential factors to be developmental bad habits (tobacco smoking regardless of the amount, regular alcohol abuse) (RR=1.299; p=0.00321), burdened hereditary history of cardiovascular diseases (essential hypertension, heart attacks and strokes) (RR=1.313; p=0.0041), type I and type II diabetes mellitus (RR=1.340; p=0.0038), obesity (RR=1.641; p=0.0043), thyroid diseases (hypothyroidism, hyperthyroidism, hyperparathyroidism) (RR=1.565; RR=1.565; p=0.00284) and adrenal (Itzen-Cushing's syndrome, adrenal cortex insufficiency) (RR=1.348; p=0.0025). The manifestations of IR should be skin rashes (OR=3.542; p=0.0033) and unwanted hair growth (OR=3.670; p=0.0029). Keywords: overweight, obesity, metabolic syndrome, vaginal microbiome, ovulation, infertility.

Study changes in insulin secretion depending on anthropometric, anamnestic and laboratory parameters using a univariate linear model

Insulin is a peptide hormone which is produced by β-cells of the pancreas. It is difficult to underestimate the effect of insulin, it has a significant impact on organs and systems. Insulin is a carbohydrate “conductor”, disorders of the regulation process of which lead to metabolic disorders and irreversible changes in the human body.Insulin resistance (IR) is a state of reduced response of tissues to the action of insulin, which leads to disorders, including the reproductive function of a woman. Long-term IR leads to the development of hyperandrogenism, as a result of which anovulatory cycles, hirsutism, skin problems, vaginal dysbiosis, and an increased rate of anxiety and depression.The objective: to determine the influence of anthropometric, anamnestic and laboratory indicators on insulin secretion before and after a load of 75 g of glucose.Materials and methods. The study included 82 women of early reproductive age. 52 women are involved in the main group, 30 women – in the control group. The patients signed an informed voluntary consent, and the main aspects of the study were explained to them. In the course of the research we developed a questionnaire and conducted a survey.Anthropometric parameters (height, body weight, waist circumference) were measured, and BMI was calculated. Laboratory indicators were studied: luteinizing hormone (LH), follicle-stimulating hormone (FSH), sex hormone binding globulin (SHBG), thyroid-stimulating hormone (TSH), prolactin, dehydroepiandrosterone-sulfate (DHEA-S), total testosterone, free testosterone index, HOMA-IR index, glucose tolerance test (GTT) + determination of insulin level, Matsuda index.Results. The conducted correlation analysis proved the relationship between the level of fasting insulin and the following indicators: WC – r = 0.321900051, BMI – r = 0.333470666, establishment of the menstrual cycle – r = -0.283517408, duration of bleeding during menstruation, TSH level – r = 0.249578215, DHEA-S – r = -0.209053013, total testosterone level – r = 0.278921593.A relationship was found between the level of insulin after a load of 75 g of glucose and the following indicators: body weight at the birth of female respondents – r = -0.238495649, gestational term of birth – r = -0.243025226, FSH level – r = 0.291379519.Conclusions. A small positive (direct) relationship was determined between the fasting insulin level and the following indicators: WC, BMI, TSH level, and total testosterone level. An increase of these indicators is associated with an increase in fasting insulin level. A slight inverse linear relationship was found between the level of fasting insulin and the duration of menstrual function, the duration of bleeding during menstruation and the DHEA-S level.A slight inverse relationship is observed between the level of insulin after load and body weight at birth, the term of birth. Lower birth weight and early gestational age are associated with increased insulin levels after load.There is a direct relationship between post-load insulin levels and FSH levels. An increased FSH concentration will lead to a rise of insulin level after load.

Contraceptive behavior of women in India after induced abortion.

Putting an end to the silent pandemic of unsafe abortion is a major public health concern globally. Adoption of post-abortion contraception is documented as a significant contributor to reduce the number of unintended pregnancies and number of induced abortions. This study aimed at investigating the post abortion contraceptive behavior of Indian women exploring the determinants of post-abortion contraceptive uptake. Retrospective calendar data for 6,862 women aged 15-49 years from fifth round of National Family Health Survey (2019-2021) was used for the study. Multinomial logistic regression method was used to model the determinant factors to post-abortion contraceptive uptake. 72.6% women reported adopting no method of contraception after the abortion procedure. A total of 27.4% women adopted some method of contraception after abortion. 14% women preferred adopting short term modern methods. Women in early reproductive age group which is the most vulnerable group in experiencing unintended pregnancies are less likely to adopt any contraceptive method after abortion. Uptake of post abortion contraception is quite low in India. Effort should be taken in the direction of bringing awareness through provision of targeted contraceptive counselling after abortion.

ерсонифицированный подход к диагностике и лечению рецидивирующих форм бактериального вагиноза

According to world statistics, bacterial vaginosis (BV) occupies one of the first places among vaginal diseases. The frequency of its distribution in the population ranges from 12% to 80% and depends on the contingent of women examined. BV develops mainly in women of reproductive age: in 80–87% of women with pathological vaginal discharge and 37–40% of pregnant women. Aim. To evaluate the effectiveness of three-stage therapy for recurrent and combined forms of BV based on the characteristics of the microbiome of the genital tract in women of early reproductive age. Materials and methods. We observed 445 women, who were divided into the following clinical groups. The IP group included 174 (39.10±2.31%) women with a confirmed diagnosis of recurrent BV. The IIP group included 153 (34.38±2.25%) women in whom BV was combined with cervicitis of nonspecific etiology. Group IIIP included 85 (19.10±1.86%) patients with a verified diagnosis of recurrent BV in combination with vulvovaginal candidiasis. The comparison group included 33 (7.42±1.24%) women, whose examination results corresponded to the reference values. Verification of the diagnosis in patients was carried out when contacting the antenatal clinic, based on the anamnesis, the nature of the complaints, and the results of clinical and laboratory examination methods. Laboratory examination included: pH – measurement of vaginal fluid using colpotest; bacterioscopic (urethra, cervical canal, vagina, rectum), bacteriological examination and polymerase chain reaction method in real time characterized the vaginal biotope. Patients with recurrent BV were offered three-stage therapy according to a personalized algorithm we developed, taking into account concomitant vaginal pathology. Results. The data obtained indicated an improvement in the quality of life of patients who underwent a course of three-stage therapy. The clinical effect showed that there were no relapses of the disease in patients of the IIIP group in 83% of cases, in the IIP and IP groups – in 90% and 91% of women, respectively. The highest frequency of relapses after therapy after 6 and 12 months was observed in patients of group IIIP, which amounted to 6% and 8% of Clinical cases (p<0.05). Conclusion. Our data indicate that the use of the proposed diagnostic algorithm and three-stage therapy for recurrent and combined forms of BV made it possible to reduce the frequency of reproductive losses in patients in the prospective study groups: spontaneous miscarriages in early and late gestation – in 6.29, ectopic pregnancies – by 5.54 times, premature births by 3.65 times. The frequency of normal term births in women in the prospective study groups after three-stage therapy increased by 1.4 times.

Pharmacological Protection of Ovaries During Program Drug Chemotherapy in Classical Hodgkin Lymphoma and Non-Hodgkin Lymphoma Patients

Aim. To assess the efficacy of ovarian protection and options for fertility preservation with the use of gonadotropin-releasing hormone agonists (a-GnRH) in patients with classical Hodgkin lymphoma (cHL) and non-Hodgkin lymphomas (NHLs) during program drug chemotherapy.
 Materials & Methods. The study enrolled 247 female patients (187 with cHL and 60 with NHLs) undergoing program drug chemotherapy from 2019 to 2023. The patients were aged 13–42 years (median 24 years). Prior to chemotherapy and after it was completed, the serum anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), and estradiol levels were measured. Besides, antral follicle count was estimated by pelvic ultrasound. To provide ovarian protection during chemotherapy, a-GnRH was administered to 67 (27 %) out of 247 patients. Ovarian reserve was assessed based on ultrasound and AMH, FSH, and estradiol levels in 2–3 months after completing the program of drug chemotherapy or after spontaneous menstrual recovery.
 Results. Menstrual cycle recovered in 194 (78.5 %) out of 247 patients, regardless of lymphoid malignancy variant. Among them, there were 79.7 % (n = 149) of cHL patients and 75 % (n = 45) of NHL patients. Accordingly, ovarian function was lost in 20.3 % (n = 38) of cHL patients and 25 % (n = 15) of NHL patients. Predictors of ovarian function recovery appeared to be age ≤ 28 years and AMH level > 2.45 ng/mL. Pharmacological protection of ovaries did not impact the probability of menstrual cycle recovery. Regardless of immunomorphological variant of lymphoid malignancy, a regular menstrual cycle was completely restored in 48 (71.6 %) out of 67 a-GnRH recipients and in 146 (81.1 %) out of 180 patients without a-GnRH treatment.
 Conclusion. Most of cHL and NHL patients of early reproductive age (≤ 30 years) have a fair chance of menstrual cycle recovery after completing the program drug chemotherapy similar to BEACOPP, EACODD(PP)-14, R-CHOP, R-Da-EPOCH and other regimens. Ovarian reserve cannot be preserved by means of a-GnRH administration during chemotherapy. High baseline FSH and low baseline AMH levels indirectly indicate evidence of impaired ovarian reserve. Patients belonging to this category are those who, if intensive combined cytostatic therapy regimens are planned, should undergo prior oocyte/embryo retrieval with subsequent cryopreservation due to the risk of premature loss of ovarian function.

СРАВНИТЕЛЬНЫЙ АНАЛИЗ КЛИНИКО-АНАМНЕСТИЧЕСКИХ ХАРАКТЕРИСТИК ПЕРВОБЕРЕМЕННЫХ ЖЕНЩИН В КРУПНОМ ПРОМЫШЛЕННОМ РЕГИОНЕ ЮГА КУЗБАССА В ЗАВИСИМОСТИ ОТ ИСХОДОВ

Objective. To identify the peculiarities of the clinical and anamnestic characteristics of first-time pregnant women with undeveloped pregnancy in a large industrial region by example of the southern agglomeration of Kuzbass. Material and methods. In the period from 01.09.2021 to 15.08.2023, 358 first-time pregnant women were observed. The main group included 172 patients with undeveloped pregnancy, the comparison group consisted of 186 women with physiologic labor. The study results were entered into MS Excel database and processed using IBM SPSS Statistics 27 program. The significance of differences was evaluated using Kolmogorov-Smirnov criteria with Lilliefors correction, Mann-Whitney, Pearson's chi-squared, and Fisher's test. Differences were considered statistically significant at p < 0.05 Results. First-time pregnant women with undeveloped pregnancy were significantly less likely to have endocrine (p<0,001), respiratory (p<0,001), cardiovascular (p<0,001), gastrointestinal (p=0,007), thyroid (p=0,016), nervous system (p<0,001), visual (p<0,001) and urinary (p<0,001) diseases. At the same time, patients were significantly more likely to be unmarried (p<0.001), live in a ‘sleeping’ area of the city (p<0.001), suffer from algodismenorrhea (p=0.016), vulvovaginal candidiasis (p<0.001), and their vaginal microbiota was dominated by conditionally pathogenic microflora (p <0.001), elements of the removed fetal egg had inflammatory changes (p <0.001). Conclusions. The first undeveloped pregnancy in somatically healthy women of early reproductive age and in the absence of an aggravated obstetric and gynecologic history prompts the search for new pathogenetic mechanisms of failed gestation.

Аномальные маточные кровотечения пубертатного периода и COVID-19: этиология и патогенез

The analysis of scientific papers published in eLibrary, PubMed, Google Scholar for 2020–2023 is carried out. The clinical recommendations ‘Abnormal uterine bleeding in puberty’, methodological recommendations of the Ministry of Health of the Russian Federation ‘Features of clinical manifestations and treatment of the disease caused by a new coronavirus infection (COVID-19) in children’ and temporary methodological recommendations of the Ministry of Health of the Russian Federation ‘Prevention, diagnosis and treatment of a new coronavirus infection (COVID-19)’ were analyzed. There is a clear link between the increase in the number of hospitalized girls of early reproductive age with abnormal uterine bleeding of the puberty period (AUB PP) and the transferred COVID-19. In order to improve, predict and optimize the tactics of management and treatment of girls with AUB PP and coronavirus infection, the impact of COVID-19, the features of their etiology and pathogenesis were analyzed. Given the high degree of chronic course and the tendency to relapse, it is necessary to develop a methodology to assess the likelihood of a repeat case of AUB PP, including based on the pathogenetic features of the impact of COVID-19 on the menstrual cycle

POST-COVID-19-syndrome in young healthy women: myth or reality?

Aim. To assess the incidence and severity of new persistent symptoms in somatically healthy young women with and without a history of COVID-19.
 Materials and methods. The main study group included patients who had PCR-confirmed COVID-19 in JulyOctober 2021 (n=181); the comparison group included women without COVID-19 during this period (n=71). Inclusion criteria: female sex, age 1835 years, no pregnancy, overweight/obesity, diabetes mellitus, chronic hypertension, premenstrual syndrome, and other somatic and/or chronic infectious diseases. Post-COVID syndrome (PCS) was diagnosed based on symptoms absent before COVID-19, appeared 4 weeks from the disease onset, and lasted at least 2 months, which could not be explained by alternative diagnoses. We used primary medical records and interviewed patients using a special questionnaire to develop a statistical database. The severity of symptoms was assessed using a 10-point scale.
 Results. New persistent symptoms during the pandemic in young, initially somatically healthy women with and without COVID-19 were reported with similar frequency: 96.1 and 93.0%, respectively (odds ratio OR 1.88, 95% confidence interval CI 0.586.14; p2=0.327). Only patients with COVID-19 reported cough (43.6%), shortness of breath (26.5%), chest pain (18.2%), weight loss (18.8%), hair loss (60.8%); in the comparison group, these symptoms were not reported; p20.001. Patients with PCS were more likely to experience memory impairment 49.2% vs 12.7% (OR 6.66, 95% CI 3.1314.21; p20.001); headache 43.1% vs 11.3% (OR 5.96, 95% CI 2.713.17; p20.001); depression 19.9% vs 8.5% (OR 2.69, 95% CI 1.086.7; p2=0.029); myalgia 31.5% vs 8.5% (OR 4.98, 95% CI 2.0412.17; p20.001). Patients of both groups showed similar frequency of fatigue (69.0% vs 71.8%; p2=0.66), drowsiness (54.9% vs 43.6%; p2=0.11), palpitations (19.7% vs 29.8%; p2=0.1), menstrual cycle changes (22.5% vs 21.0%; p2=0.865), and skin manifestations (2.8% vs 6.6%; p2=0.24). COVID-19 survivors had a more pronounced memory impairment (4.0 vs 1.0 points; p0.001), headache (5.0 vs 3.0 points; p=0.001), myalgia (5.0 vs 1.0 points; p0.001) and less severe insomnia (3.0 vs 5.0 points; p=0.004).
 Conclusion. The PCS symptoms are common in initially somatically healthy women of early reproductive age. Similar symptoms in women with no history of COVID-19 may be due to post-traumatic stress anxiety disorder. Further interdisciplinary research is needed to identify the pathophysiological mechanisms for the occurrence of new persistent symptoms in different age and social groups during the COVID-19 pandemic.

Phytocompositions of ayurvedic medicine in the restoration of menstrual health in women of early reproductive age who have survived moderate and severe form of COVID-19

Research objectives: to evaluate the effectiveness of phytotherapy in the treatment of menstrual health disorders in women of early reproductive age after a moderate and severe form of the coronavirus disease.Material and methods. 104 women of early reproductive age with menstrual health disorders that occurred 3 months later after moderate or severe COVID-19 were under observation and 34 gynecologically and somatically healthy women of the control group who did not suffer from COVID-19. Female patients with COVID-19 were randomly divided into two groups: the main group (n=53) and the comparison group (n=51). The performed examination included: study of complaints, general and gynecological anamnesis, physical and gynecological examination, ultrasound examination of pelvic organs, determination of hormonal profile. All patients with COVID-19 received a comprehensive rehabilitation program, which included diet therapy, vitamin and mineral complexes, psychotherapy. In addition to the complex rehabilitation program patients of the main group received ayurvedic phytocompositions Femicycle or Femimens for 6 months.Results. It has been established that the moderate and severe course of the coronavirus infection affects the reproductive system of early reproductive aged women and leads to menstrual health disorders, among which irregular menstruation, premenstrual syndrome and dysmenorrhea dominate. Levels of pituitary, adrenal, ovarian and thyroid serum hormones were within the reference norm in most cases, but have statistically significant deviations from similar indicators of healthy control women who did not have COVID-19. One-third of women of early reproductive age after moderate to severe COVID-19 had elevated prolactin levels. Ayurvedic phytocompositions Femicycle and Femimens in a comprehensive rehabilitation program for post-COVID menstrual health disorders led to a faster recovery of menstrual health and a full hormonal recovery.Conclusions. Ayurvedic phytocompositions Femicycle and Femimens are effective and safe naturopathic drugs for restoring menstrual health in women of early reproductive age after experiencing moderate to severe COVID-19.

The Inquiry Into the Causes of Pelvic Inflammatory Diseases in Early Reproductive Age Women

Pelvic Inflammatory Disease (PID) is a clinical syndrome of the female reproductive tract characterized by inflammation of the endometrium, fallopian tubes, or peritoneum. PID occurs when microorganisms ascend from the vagina or cervix to the fallopian tubes and other upper genital tract structures. PID can result from untreated bacterial infections, including chlamydia and gonorrhea, and can lead to infertility, ectopic pregnancy, and chronic pelvic pain.

Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio are useful markers of inflammation in polycystic ovary syndrome?

Background: Polycystic ovary syndrome (PCOS) is a heterogeneous metabolic disorder characterized by hyperinsulinemia, abnormal lipid levels, altered hormonal milieu such as elevated androgen levels, and chronic anovulation. PCOS is one of the important reasons for infertility. PCOS is the most common cause of irregular menstruation with diverse clinical manifestations affecting women of reproductive age. Aims and Objectives: The present study aimed to examine systemic inflammatory markers that can be detected in complete blood count, such as neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR), in patients with PCOS and to compare them with healthy women. Materials and Methods: This case–control study was conducted in the Department of Obstetrics and Gynecology, Akash Institute of Medical Sciences and Research Centre, Devanahalli, Bengaluru, Karnataka. After following the inclusion and exclusion criteria, a total of 160 subjects were included. Among them, 80 were PCOS patients as cases and 80 were healthy women as controls. A detailed clinical and gynecological history was obtained from all subjects. Women presenting gynecology OPD in the group of 15–45 years with irregular menstrual cycles were included in the study. The diagnosis of PCOS was done according to the Rotterdam criteria, diagnosis of PCOS requires the presence of at least two of the following three symptoms: (1) oligomenorrhea/polymenorrhea; (2) biochemical hyperandrogenism (Ferriman–Gallwey scores of ≥8) or the presence of clinical hyperandrogenism; and (3) detection of polycystic ovaries in an ultrasonographic examination (≥12 follicles, 2–10 mm in size). Under aseptic conditions, venous blood samples were collected from all the subjects to assess the hormones such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), inflammatory markers, white blood cells, neutrophils (N), lymphocytes (L), and platelets. NLR and PLR were calculated. Lipid profiles were obtained in the fasting state. Results: In the present study, BMI 24.5±4.1 kg/m2, total cholesterol 160.1±24.2 mg/dL, triglyceride 99.1±28.1 mg/dL, LDLC 99.1±25.1 mg/dL, LH 8.4±3.8 mIU/mL, LH/FSH ratio 1.2±0.91, lymphocytes 16.30±4.69, NLR 5.73±1.91, and PLR 17.01±7.13 were significantly increased in PCOS cases and HDLC 39.7±6.2 mg/dL and FSH 6.1±1.1 mIU/mL were decreased in PCOS cases compared to healthy controls. Conclusion: The study concludes that increased inflammatory markers such as NLR and PLR in PCOS cases compared to the age-matched individuals in the control group, suggesting the presence of chronic low-grade inflammation in PCOS cases of early reproductive age.

Adolescent menstrual dysfunction as a marker of future disorders of women’s sexual and reproductive health

The literature review considers the health state in women of early reproductive age. This is related to the common factors of formation that arise in adolescence, and are clinically manifested in the reproductive age. Disorders of the reproductive system functioning in puberty often lead to infertility, obstetric complications and perinatal losses. Ghrelin is a factor in the pathogenesis of functional amenorrhea during weight loss. Its concentration has a negative correlation with body mass index and androgen levels in the female body. Excessive physical exertion is one of the causes of functional amenorrhea, because this pathology is associated with increased levels of β-endorphin and ghrelin, as well as extremely low concentrations of leptin. Recent researches have demonstrated the importance of hidden genetic reproductive polymorphisms in women with the above-mentioned risk factors for amenorrhea for the future impairment of fertility. That is why women without genetic polymorphisms are able to restore both menstrual and reproductive functions after eliminating the influence of risk factors. However, in patients with some types of genetic mutations, amenorrhea persists despite the normalization of body weight, disappearance of stress and/or reduction of physical exertion. Under conditions of war in Ukraine, there is an increase in the frequency of hypothalamic dysfunctions in women of active reproductive age with a decrease in body weight against the background of stress, head injuries, which gives the problem an extreme acuteness and urgency. An example of a clinical manifestation of functional gonadotropin insufficiency is a menstrual disorder with the formation of secondary amenorrhea in 35 % of cases. Stress-induced (psychogenic) amenorrhea is one of the most common causes of functional gonadotropin deficiency. Menstrual and sexual female dysfunction is a multifactorial disorder that impairs women’s fertility, leads to pregnancy loss, infertility, and abnormal gestation. Due to dysmetabolic disorders, violations of ovarian steroidogenesis with hypothalamic-pituitary imbalance, this problem becomes multidisciplinary.

THE PREVALENCE OF MORPHOLOGICAL CHANGES IN OVARIES IN DIFFERENT AGE GROUPS WITH POLYCYSTIC OVARY SYNDROME

Background: Polycystic ovary syndrome (PCOS) is a common endocrinophathy disorder affecting reproductive aged women and frequently manifest during early reproductive age. It is a heterogeneous disorder, with multiple reproductive, cosmetic and metabolic complexities which is characterized by dysfunction in ovulation and clinical or biochemical hyperandrogenism and the presence of polycystic ovarian morphology. It is the most common endocrine cause of infertility, increased risk of adverse pregnancy outcome, metabolic syndrome, type 2 diabetes mellitus, and some carcinoma. For these reasons a correct and early diagnosis of this syndrome is fundamental, as it allows performing the most appropriate treatments and check-ups thus reducing the risk of developing all the complications related to it. Objectives: To measure the ovarian morphology in different age groups of adolescent and adult women with polycystic ovary syndrome. Methods: In this observational crossectional study 150 married or unmarried adolescent and adult women with PCOS were subdivided into three equal age-based groups of 50 each: 12 – 28 years (group 1), 29-36 years (group II) and 37-50 years (group III). The ovarian volume, ovarian area, ovarian stromal area, follicles count and size were determined by trans-abdominal and trans-vaginal scans. All statistical procedures were performed using SPSS 20.0 for Windows (IBM SPSS Statistics, IBM software). Values are expressed as mean ± standard deviation and compared by one-way Anova p<0.05 is considered signicant. Test for normality was done using Kolmogorov-Smirnov test. Bonferroni correction for multiple comparisons was applied. Conclusion: In this study, ovarian area showed a positive correlation with age in women with polycystic ovaries. There were no signicant changes in ovarian volume, ovarian stromal area, and follicle count during reproductive ages until the perimenopause. It was observed a moderate negative correlation of age with follicle size.

Alcohol consumption and the risk of new-onset uterine leiomyomas: a nationwide population-based study in 2.5 million Korean women aged 20 to 39 years

Uterine leiomyomas are the most common benign tumors in women of childbearing age. Although there are several studies reporting the positive association of drinking alcohol with the incidence of uterine leiomyomas (UL), studies targeting Korean women are lacking. This study aimed to investigate the association between alcohol consumption and the risk of new onset UL in early reproductive age Korean women. This was a retrospective nationwide population-based cohort study using the Korean National Health Insurance Service (K-NHIS) database. Participants comprised 2,512,384 asymptomatic Korean women aged 20-39 years who underwent a national health examination during 2009-2012. Follow-up period was from the date of first national health examination to the date of diagnosis of new-onset UL or December 2018 if no UL was detected. The diagnosis of UL required two outpatient records within a year or one inpatient record of International Classification of Disease, 10th revision (ICD-10) codes of UL (D25), in the K-NHIS. Exclusion criteria were previously diagnosed UL during the screening period (January 2002 to the date of first health examination) or UL diagnosis within 1 year of baseline examination. The association between alcohol consumption, amount drunk per drinking session, and sustained drinking over time and the risk of new-onset UL were investigated. About 6.1 % of women aged 20-39 years were diagnosed with UL after an average of 4.3 years. Alcohol consumption was associated with an increased incidence of new onset UL of 12-16% (HR 1.12, 95% CI 1.11-1.14 for mild-to-moderate drinkers; HR 1.16, 95 % CI 1.12-1.20 for heavy drinkers). Drinking one or more days per week was associated with an increased risk of UL (HR 1.11, 95 % CI 1.10-1.12 for 1 day/week drinking; HR 1.15, 95 % CI 1.12-1.17 for ≥3 days/week drinking), and the association increased proportionately to the amount of alcohol consumed per drinking session (HR 1.17, 95 % CI 1.15-1.19 for ≥7 glasses/drinking session). Women who also reported alcohol consumption in the questionnaire administered two years later (sustained drinkers) exhibited a 20% increased risk of new-onset UL (HR 1.20, 95 % CI 1.17-1.22) compared to women who answered that they did not drink alcohol at both times (sustained non-drinkers). In women who discontinued drinking, the risk was 3% (HR 1.03, 95 % CI 1.01-1.06), whereas in women who became drinkers, the risk was 14% (HR1.14, 95 % CI 1.11-1.16). An alcohol drinking habit, the amount of alcohol consumed per drinking session, and sustained drinking over 2 years were significantly associated with the risk of new-onset UL. Avoiding or discontinuing drinking could lower the risk of new-onset UL in early reproductive-aged women.

Improvement of diagnostic methods of reproductive health disorders in women of early reproductive age with sexual dysfunction and hypoandrogenism

Female sexual dysfunction (FSD) is a global health problem. This is a multifaceted problem that requires the coordinated interaction of many neurotransmitters and hormones, both central and peripheral. In young women with reproductive health problems, the first clinical signs of future imbalances manifest in adolescence. Disruption of adaptation mechanisms at this age leads to the activation of polymorphic genes, resulting in the multifunctional disorders of women’s health in the future. In particular, the role of vitamin D deficiency as a trigger in the formation of many immune‑hormonal imbalances is noted, including formation of methionine metabolism disorders and the accumulation of excess homocysteine in cells. Therefore, improving methods of diagnosing reproductive health disorders in women of early reproductive age with sexual dysfunction and hypoandrogenism can be considered as a method of preventing the formation of conditions in them for future fertility disorders, decreased ovarian reserve, and infertility.
 Objective — to improve methods to diagnose the reproductive health disorders in women of early reproductive age with sexual dysfunction and hypoandrogenism.
 Materials and methods. The research included 20 women of early reproductive age with symptoms of FSD and hypoandrogenism (group I) and 20 healthy women (group II). The hormonal reproductive background was determined on the 5—7th day of the menstrual cycle in all examined women, including levels of thyroid‑stimulating hormone (TSH), antibodies to thyroid peroxidase (TPO‑Ab), vitamin D, homocysteine. IBM SPSS Statistics version 25.0 software was used for statistical processing of the obtained data.
 Results. Vitamin D deficiency significantly raised the probability of decreased levels of luteinizing hormone (LH) (R2=0.705; p<0.001), estradiol (R2=0.320; p=0.022), free testosterone (R2=0.419; p=0.007), dihydroepiandrosterone sulfate (DHEA‑S) (R2=0.697; p<0.001) and increased levels of prolactin (R2=0.691; p<0.001), 17‑OP (R2=0.748; p<0.001). Hyperhomocysteinemia did not significantly affected the changes in the levels of these hormones (p>0.05), but significantly increases the probability of decreased FSH levels (R2=0.376; p=0.012). Moreover, it was established that high TSH levels increased the probability of elevation homocysteine rates (R2=0.561; p=0.001) and decreased levels of reproductive hormones: FSH (R2=0.357; p=0.014), LH (R2=0.626; p<0.001), estradiol (R2=0.451; p=0.004), free testosterone (R2=0.587; p=0.001) and DHEA‑S (R2=0.661; p<0.001). The increased TPO‑Ab levels can serve as a significant predictor of the increased prolactin levels (R2=0.675; p<0.001).
 Conclusions. Optimization of the medical care to women with FSD should include early diagnosis of vitamin D status and evaluation of homocysteine levels. Determination of women’s hormonal background should include assessments of the levels of TSH and antibodies to thyroperoxidase. An endocrinologist’s consultation is required in case of the reveal of thyroid gland disorders. The assessments of polymorphism of folate‑methionine cycle genes and thrombophilia should be performed in case of high levels of homocysteine.

ANALYSIS OF THE COURSE OF PREGNANCY, CHILDBIRTH AND THE STATUS OF NEWBORNS BORN BY DISPLACED WOMEN

Aim of the study: to analyse the effect of involuntary migration on the course of pregnancy, labour and delivery, and neonatal outcomes in pregnant women in the third generation. Materials and methods. This paper presents an analysis of a prospective study of the course of pregnancy, childbirth, and the condition of new-born infants born by displaced Azerbaijani women. A prospective analysis was made in the course of puberty and the state of reproductive health in 54 refugee women of early reproductive age, who were divided into two groups, aged 18-25 and 26-35 years. Results. A study conducted among third generation women revealed pronounced negative trends in both somatic and reproductive health among refugee women in this group. Their average age ranged from 18 to 35. Most of the patients, 37 (68.5%), were born with a birth weight of less than 3000g. The mean age of parents at the time of girl's birth was 25.4±2.26 years for mothers, 26.9±5.29 years for fathers, i.e., in the immediate post-stress period. The subjects are characterized by menstrual cycle dysfunction (63%-29.5%). Hypermenorrhoea occurs in 46% of the subjects, primary amenorrhoea in 8.2%, and secondary amenorrhoea in 3.3%. There is also a high percentage of inflammatory diseases of the female genital organs (93.4%). A high percentage of somatic pathologies is found in the female patients: iron deficiency anaemia - 77.8%, gastrointestinal diseases - 48.1%, thyroid diseases - 9.3%, urinary diseases - 22.5%, helminthiasis - 16.7%, etc. Sexually transmitted infections were diagnosed in chronic form in 14 patients. The rate of placental insufficiency of grade 1a and 1b was diagnosed in 29%-16%, and delayed foetal development of grade 1 and 2 in 12%-8% respectively. Asphyxia (27%), newborn hypotrophy (7.5%), prematurity (18%) is characteristic of the newborns of this group of patients. Conclusion. Analysis of the results of a comprehensive study of the health of pregnant refugee women has shown that even in the third generation the stress associated with forced migration of the older generation and adverse socio-medical problems are reflected in the formation and functioning of the reproductive age of the younger generation.

Utilization of Antenatal Care and Pregnancy Outcomes of Women in Advanced Maternal Age at a Tertiary care Hospital in Sri Lanka

Introduction: Childbearing in latter part of reproductive age is challenging. Adverse pregnancy outcomes increase with advanced (>35 years) maternal age (AMA) and comprehensive antenatal care (ANC) usage by AMA women improves their pregnancy outcomes. However, no recent local data are available on the AMA and pregnancy outcomes. Objectives: To describe utilization of ANC and pregnancy outcomes of AMA women delivering at North Colombo Teaching Hospital and assessed the association between utilization of ANC services and selected pregnancy outcomes. Methods: A descriptive cross-sectional study was conducted among 216 women aged >35 years delivered at Colombo North Teaching Hospital selected using a non-probability consecutive sampling method. Women were interviewed within 7 days postpartum inward using an interviewer-administered questionnaire. Selected data were extracted from clinical records. Key elements of ANC (booking visit, type, frequency, services etc.) were scored and their association with pregnancy outcomes were assessed. Results: A total of 216 AMA postpartum women (age range 35–45 years, mean 37.8 (SD=2.4)) were recruited (response rate 100%). Majority (91.7%, n=198) were multiparous. The current pregnancy was planned in 77.8% (n=168) and 52.7% (n=114) experienced antenatal morbidities. Adverse maternal (8.3%, n=18) and newborn (37%, n=80) outcomes were noted. Majority (75.9%, n=164) optimally utilized ANC. Sinhalese (OR=2.98, 95%CI 1.29–6.87, p=0.008), Buddhist (OR=2.53, 95%CI 1.33–4.80, p=0.004) women with intended pregnancies (OR=5.67, 95%CI 2.81–11.43, p<0.001) well utilized ANC. Women educated <10 years of formal education (OR=0.4, 95%CI 1.33–4.80, p=0.027), had contraceptive issues (OR=0.27, 95%CI 0.10–0.74, p=0.007) and had adverse newborn outcomes (OR=0.32, 95%CI 0.16–0.61, p=0.001) reported low tendency to utilize ANC. Conclusions: Many AMA women are multiparous and with planned pregnancies. Presence of adverse maternal & newborn outcomes is substantial. Majority well utilized ANC and it reduced adverse pregnancy outcomes. Effective strategies should be formulated to promote well-planned pregnancies in early reproductive ages of women.

POLYCYSTIC OVARY SYNDROME: A MODERN VIEW ON THE PROBLEM

The author of this article presents a modern understanding of the problem of polycystic ovary syndrome (PCOS). PCOS is a multifactorial, genetically determined pathological condition, in the pathogenesis of which an important role belongs to disorders of gonadotropic regulation, hyperandrogenism, insulin resistance, adipose tissue dysfunction and other factors. Obviously, PCOS is a socially significant gynecological pathology of early reproductive age, which requires optimization of the diagnosis and management of such patients from adolescence. In adolescents, PCOS is diagnosed in the presence of clinical hyperandrogenism and an irregular menstrual cycle, while ultrasound criteria are not always reliable. For an individual approach and choice of treatment tactics, it is extremely important to verify the diagnosis of PCOS in a timely manner, determine the clinical phenotype and take into account the reproductive plans of the patient.

Вторичная профилактика опухолей репродуктивной системы у женщин, проживающих в городских и сельских условиях

Aim: to analyze specific aspects of diagnosing reproductive system disorders in women depending on the place of residence, medical activity and awareness of the female population, staffing resources and the availability of equipment in medical institutions. Patients and Methods: the analysis covered medical records of 9,785 women who, at their own volition, visited the medical center for medical check-up. Gynecological examination, colposcopy, liquid-based cytology, pelvic and breast ultrasound examination, and mammography were performed in all patients. The patients were asked to fill out a questionnaire including the following data: conditions of life and work, lifestyle, and risk factors of malignant tumors of the female reproductive system. Results and Discussion: women over 40 years of age were more concerned about their health status. Thus, it is necessary to find mechanisms for the additional motivation of women of early and middle reproductive age for expanding the screening coverage. It was found out that the differences in the organization of secondary prevention of reproductive system tumors in women living in the urban and rural environments are underpinned by the impact of demographic and social factors, characteristics of medical activity of the population, and staffing shortages in healthcare institutions. These aspects should be taken into consideration for developing methods aimed at overcoming the current failures in the diagnostic process. Conclusion: the establishing of regional "Women's Health Centers" based on multi-disciplinary comprehensive approach will help to improve the detection of tumors of the female reproductive system at the pre-cancer stage, facilitate the timely identification and mitigation of the risk factors of tumor development, and to ensure the prevention of recurrences and progression of hyperplastic processes of the reproductive system in women. KEYWORDS: tumors of reproductive system, prevention, diagnosis, organizational measures. FOR CITATION: Aminodova I.P., Vasiliev M.D., Makarova E.V., Makarova V.I. Secondary prevention of reproductive system tumors in women living in the urban and rural environments. Russian Journal of Woman and Child Health. 2023;6(2):112–118 (in Russ.). DOI: 10.32364/2618- 8430-2023-6-2-112-118.