Gynecological Morbidity Research Articles

SAHELI: Study and Action on Hysterectomy: Evidence on women’s health through the life course in India. Protocol for a mixed-methods study

Hysterectomy, removal of the uterus, is a commonly performed surgery for gynaecological morbidities. Emerging evidence indicates that hysterectomy performed before age 45 (early hysterectomy), is associated with considerable risks to women’s health. While most evidence on hysterectomy is from high-income settings, national surveys from India report high prevalence of early hysterectomy in specific regions, as well as higher prevalence amongst women in rural areas and with less education. The median age at hysterectomy in India is close to ten years before the onset of natural menopause. India has recently introduced national guidelines to address early hysterectomy, but large evidence gaps on the causes and consequences remain – which in turn limits the potential effectiveness of interventions at the clinical, health system and community level. Methods SAHELI is a Team Science study that will examine: (i) individual, social and health system determinants of early hysterectomy; (ii) women’s treatment pathways to hysterectomy and for gynaecological morbidity in general; and (iii) the consequences of undergoing hysterectomy on women’s physical, mental, economic and social well-being across the life course. This mixed-methods study includes population surveys amongst women in ages 25–49 in three high-prevalence states; qualitative health systems research to trace treatment journeys with women, health care providers and other stakeholders; evidence syntheses; and knowledge translation activities to ensure findings inform co-produced strategies and interventions. The study is grounded in a feminist epidemiology approach, aiming to examine individual and structural causes of vulnerability and prioritising the views of women, particularly in knowledge translation. Conclusions SAHELI, implemented by an all-women, multi-disciplinary team, is the first study in India to examine the causes and consequences of hysterectomy in a life course approach. We aim to influence interventions, policy and future research on women’s health, particularly access to quality gynaecological care and comprehensive health services through the life course.

A study on the gynecological morbidity among women in reproductive age group in a rural area in Kannur district

Background: Concern for the health of women in poorer nations, is on the rise. Despite being more frequent than ill health during pregnancy, gynecological illnesses are often missed. These issues have a large effect on the lives of women creating discomfort and social fallout. There are only a few studies in Kerala dwelling into this subject. This was a pioneer study in Kannur looking into women’s gynecological issues. Methods: Cheruthazham Panchayat in Kannur district, serves as the field practice area for the department of community medicine at the Government Medical College in Kannur. Here a community-based descriptive research was conducted including 404 women, between June 2017 and July 2018. Relevant data was gathered utilizing a pre-tested, semi-structured questionnaire and SPSS was used for data analysis. Results: The study population’s mean age was 32.20±10.741 years. 81.7% was the prevalence of gynecological morbidity in the study. Menstruation related problems (68.1%) formed the majority of them. Gynecological morbidity was significantly associated with age at menarche, religion and education. Menstrual disorders and dysmenorrhoea also had significant associations with age at menarche, age and factors like parity, marital status, sexual activity. 30.6% of women sought treatment for their gynecological morbidity. Conclusions: The prevalence of gynecological morbidity was very high among the study population, but the treatment seeking behaviour was very low. Education and guidance on identifying and managing these issues should be provided so as to improve their quality of life.

Persistent endocrine-disrupting chemicals and incident uterine leiomyomata: A mixtures analysis

BackgroundUterine leiomyomata (UL; fibroids) are hormone-dependent neoplasms that can cause significant gynecologic morbidity. Studies have documented associations between concentrations of persistent endocrine-disrupting chemicals (EDCs) and UL incidence; however, few have assessed the effects of EDC mixtures on UL. MethodsIn the Study of Environment, Lifestyle, and Fibroids, a prospective cohort study, participants attended study visits at baseline and approximately every 20 months for up to 10 years; at each visit, they completed questionnaires, provided blood samples, and underwent standardized ultrasound examinations. In baseline plasma samples (n = 1155), we quantified concentrations of polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs), and organochlorine pesticides using high-resolution mass spectrometry. We selected nine EDCs detected in >60 % of samples (4 PCBs, 4 PBDEs, and 2,2-bis(4-chlorophenyl)-1,1-dichloroethene (p,p’-DDE)) and conducted probit Bayesian kernel machine regression with hierarchical variable selection to estimate effects of the EDC mixture and individual EDCs on UL incidence, adjusting for potential confounders. ResultsDuring 10 years of follow-up, 32 % of participants developed ultrasound-detected UL. The EDC mixture was not appreciably associated with the probit of UL (β comparing all EDCs at their 75th vs. 50th percentile:= − 0.01, 95 % credible interval [CrI]: −0.11, 0.10). However, individual EDC concentrations were associated with UL in opposing directions: PCB138/158 was positively associated with UL (β for 25th-to-75th-percentile increase when all other chemicals were set to their 50th percentile = 0.18, 95 % CrI: −0.09, 0.44), whereas PBDE99 and p,p’-DDE were inversely associated with UL (β = −0.06, 95 % CrI: −0.21, 0.10 and β = −0.12, 95 % CrI: −0.34, 0.10, respectively). There was little evidence of interaction between EDCs. ConclusionIn this prospective ultrasound study, a mixture of persistent EDCs was not appreciably associated with incident UL during 10 years of follow-up, but individual EDCs were associated with UL in opposite directions.

ETS1 drives EGF-induced glycolytic shift and metastasis of epithelial ovarian cancer cells

Epithelial ovarian cancer (EOC), a leading cause of gynecological cancer-related morbidity and mortality and the most common type of ovarian cancer (OC), is widely characterized by alterations in the Epidermal Growth Factor (EGF) signaling pathways. The phenomenon of metastasis is largely held accountable for the majority of EOC-associated deaths. Existing literature reports substantiate evidence on the indispensable role of metabolic reprogramming, particularly the phenomenon of the ‘Warburg effect’ or aerobic glycolysis in priming the cancer cells towards Epithelial to Mesenchymal transition (EMT), subsequently facilitating EMT. Considering the diverse roles of growth factor signaling across different stages of oncogenesis, our prime emphasis was laid on unraveling mechanistic details of EGF-induced ‘Warburg effect’ and resultant metastasis in EOC cells. Our study puts forth Ets1, an established oncoprotein and key player in OC progression, as the prime metabolic sensor to EGF-induced cues from the tumor microenvironment (TME). EGF treatment has been found to induce Ets1 expression in OC cells predominantly through the Extracellular Signal-Regulated Kinase1/2 (ERK1/2) pathway activation. This subsequently results in pronounced glycolysis, characterized by an enhanced lactate production through transcriptional up-regulation of key determinant genes of the central carbon metabolism namely, hexokinase 2 (HK2) and monocarboxylate transporter 4 (MCT4). Furthermore, this study reports an unforeseen combinatorial blockage of HK2 and MCT4 as an effective approach to mitigate cellular metastasis in OC. Collectively, our work proposes a novel mechanistic insight into EGF-induced glycolytic bias in OC cells and also sheds light on an effective therapeutic intervention approach exploiting these insights.

Microsatellite instability as a reliable marker of coexisting endometrial cancer in atypical endometrial hyperplasia

Background. Endometrial cancer (EC) dominates in the structure of gynecological cancer morbidity. There has been an increase in this nosology in women of reproductive age. The morphological precancerous form of endometrioid adenocarcinoma is endometrial intraepithelial neoplasia (EIN), or atypical endometrial hyperplasia (AEH), that is difficult to diagnose: there is a high percentage of underdiagnosis resulting in a wrong treatment strategy. To improve the accuracy of diagnosis, additional immunohistochemical markers are being studied that are not part of the physician»s routine practice. Extremely promising for the prognosis of endometrial malignancy is the assessment of the functioning of the genes of the DNA mismatched nucleotide repair system (DNA mismatch repair system, MMR).Aim. To assess the diagnostic value of (microsatellite instability, MSI) in patients with AEH to rule out coexisting endometrial cancer.Materials and methods. The study includes 72 histological samples: 36 cases of EIN and 36 cases of EC, 14 of which were combined with EIN. To assess the microsatellite status, immunohistochemical staining of specimens was done with the identification of 4 markers, i. e. MLH1, PMS2, MSH2, MSH6. Results. It was found that out of 36 cases of EIN, only one sample showed loss of the PMS2 and MLH1 genes, which amounted to 3 %; the remaining EIN samples showed microsatellite stability. In 5 (36 %) out of 14 cases of combined EC and EIN pathology, MSI/dMMR was identified. Eight (36 %) out of 22 EC samples were found to have MMR deficiency. Loss of PMS2 increases the likelihood of being classified as EC 9-fold (odds ratio 9.1). With that, the presence of foci of adenocarcinoma in the case of AEH if MSI is confirmed can be asserted with a probability of 93 %. The detection of MSI in a histological sample is more often associated with the presence of EC, while the loss of the PMS2 and/or MLH1 genes increases the likelihood of a cancer diagnosis. If during additional immunohistochemical analysis a loss of these genes is observed, then EC can be diagnosed, even with an ambiguous histological pattern.Conclusion. Detection of MSI/dMMR in AEH indicates the presence of foci of coexisting endometrioid adenocarcinoma with an extremely high degree of probability. Detection of MSI/dMMR in the treatment of EC is advisable at the stage of diagnosis.

Associations of per- and polyfluoroalkyl substances with uterine leiomyomata incidence and growth: a prospective ultrasound study.

Per- and polyfluoroalkyl substances (PFAS) are endocrine-disrupting chemicals used in commercial and consumer products. We evaluated PFAS exposure in relation to incidence and growth of uterine leiomyomata (UL), hormone-dependent neoplasms that are associated with severe gynecologic morbidity. We studied 1158 participants in the Study of Environment, Lifestyle, and Fibroids, a Detroit-based prospective cohort study of Black females aged 23-35 years at enrollment (2010-2012). At enrollment and four subsequent visits during 10 years of follow-up, participants attended in-person clinic visits, completed questionnaires, provided non-fasting blood samples, and underwent ultrasound for UL detection. We quantified 7 PFAS in baseline plasma samples using mass spectrometry. We used Cox regression and probit Bayesian kernel machine regression to estimate individual and joint effects of PFAS on UL incidence. We fit linear mixed models to estimate effects of individual PFAS on UL growth. We stratified by parity, an important route of PFAS elimination and determinant of UL. In individual PFAS analyses, we observed inverse associations for perfluorodecanoate (PFDA; ≥0.3 vs. <0.2 ng/ml: hazard ratio [HR] = 0.74; 95% confidence interval [CI]: 0.54-1.00) and perfluoroundecanoate (detected vs. non-detected: HR = 0.78; 95% CI: 0.61-1.01) and a weak positive association for perfluorohexane sulfonate (≥1 vs. <0.6 ng/ml: HR = 1.17; 95% CI: 0.85-1.61), while perfluorooctane sulfonate, perfluorooctanoate, perfluorononanoate (PFNA), and 2-N-methyl-perfluorooctane sulfonamido acetate (MeFOSAA) showed little association with UL incidence. The PFAS mixture was inversely associated with UL incidence, a finding driven by MeFOSAA and PFDA; however, PFNA was positively associated with UL incidence. The inverse association for PFDA and positive association for PFNA were stronger among nulliparous participants. Most PFAS showed slight inverse associations with UL growth. In this prospective ultrasound study of 1158 Black females aged 23-35 years at enrollment, we conducted a mixtures analysis to account for co-pollutant confounding and interaction. MeFOSAA and PFDA concentrations were inversely associated with UL incidence, while PFNA concentrations were positively associated with UL incidence. Concentrations of most PFAS were associated with decreased UL growth. This study contributes data to the sparse literature on PFAS exposure and UL development.

Hypertension, Cardiovascular Risk Factors, and Uterine Fibroid Diagnosis in Midlife

Fibroids are benign neoplasms associated with severe gynecologic morbidity. There are no strategies to prevent fibroid development. To examine associations of hypertension, antihypertensive treatment, anthropometry, and blood biomarkers with incidence of reported fibroid diagnosis in midlife. The Study of Women's Health Across the Nation is a prospective, multisite cohort study in the US. Participants were followed-up from enrollment (1996-1997) through 13 semiannual visits (1998-2013). Participants had a menstrual period in the last 3 months, were not pregnant or lactating, were aged 42 to 52 years, were not using hormones, and had a uterus and at least 1 ovary. Participants with prior fibroid diagnoses were excluded. Data analysis was performed from November 2022 to February 2024. Blood pressure, anthropometry, biomarkers (cholesterol, triglycerides, and C-reactive protein), and self-reported antihypertensive treatment at baseline and follow-up visits were measured. Hypertension status (new-onset, preexisting, or never [reference]) and hypertension treatment (untreated, treated, or no hypertension [reference]) were categorized. Participants reported fibroid diagnosis at each visit. Discrete-time survival models estimated hazard ratios (HRs) and 95% CIs for associations of time-varying hypertension status, antihypertensive treatment, anthropometry, and biomarkers with incident reported fibroid diagnoses. Among 2570 participants without a history of diagnosed fibroids (median [IQR] age at screening, 45 [43-48] years; 1079 [42.1%] college educated), 526 (20%) reported a new fibroid diagnosis during follow-up. Risk varied by category of hypertension treatment: compared with those with no hypertension, participants with untreated hypertension had a 19% greater risk of newly diagnosed fibroids (HR, 1.19; 95% CI, 0.91-1.57), whereas those with treated hypertension had a 20% lower risk (HR, 0.80; 95% CI, 0.56-1.15). Among eligible participants with hypertension, those taking antihypertensive treatment had a 37% lower risk of newly diagnosed fibroids (HR, 0.63; 95% CI, 0.38-1.05). Risk also varied by hypertension status: compared with never-hypertensive participants, participants with new-onset hypertension had 45% greater risk of newly diagnosed fibroids (HR, 1.45; 95% CI, 0.96-2.20). Anthropometric factors and blood biomarkers were not associated with fibroid risk. Participants with untreated and new-onset hypertension had increased risk of newly diagnosed fibroids, whereas those taking antihypertensive treatment had lower risk, suggesting that blood pressure control may provide new strategies for fibroid prevention.

Management of Artavakshaya along with Dhatukshaya in lean adolescent girls: a narration

Abstract Background: Artavakshaya (~scanty menstruation/hypomenorrhea/oligomenorrhea) is one of the most prevalent reproductive disorders among adolescent girls now. Irregular, delayed and scanty menstruation, abdominal cramping, and lower back pain are the major symptoms of Artavakshaya. The condition can be correlated with oligomenorrhea along with hypomenorrhea based on similar symptomatology. Poor nutrition, stress, hormonal disturbance, and unhealthy lifestyle are the major causes of oligomenorrhea along with hypomenorrhea particularly in lean adolescent girls. Aim and Objective: This study aims to evaluate the efficacy of Ayurveda protocol in the management of Artavakshaya in adolescent girls. The rationale behind this study was only to prevent further gynecological morbidities and cure the current condition. Materials and Methods: An unmarried female patient of 14 years of age came to the outpatient department of Prasuti Tantra and Stree Roga of Sumandeep Ayurved Medical College &amp; Hospital with chief complaints of irregular, delayed, and scanty menstruation associated with weakness and white discharge per vagina for one and half year. The patient was assessed and diagnosed with subjective criteria for menstrual abnormalities, a pictorial chart for assessment of menstrual blood, and a Visual Analog Scale. The condition was managed with Rasapachaka syrup and Saptamrita Mishrana along with lifestyle modification and Rajaswala Paricharya (~do’s and don’ts during menstrual days). The treatment lasted for 3 months and the patient was followed up for the next 1 month. Results: The findings revealed satisfactory improvement after treatment. Conclusion: The findings revealed that Artavakshaya in lean adolescent girls could be managed effectively with these Ayurveda regimens and other modern interventions avoided.

The effect of interleukin-10 gene polymorphism in the formation of deep disorders of vaginal microbiocenosis in bacterial vaginosis

Background: Bacterial vaginosis (BV) is a common vaginal infection that causes significant gynecological and obstetric morbidity. Despite modern methods and treatment regimens, BV therapy remains a difficult task due to high rates of relapses, which amount to 60% within a year after treatment. This problem, in part, can be solved by assessing the individual genetic characteristics of the organism associated with the presence of allelic variants of the immune system genes that determine the constitutional possibility of a high or low level of synthesis of the corresponding immunocompetent molecules (cytokines, pattern-recognition receptors, etc.). The aim of the study: To determine the significance of the polymorphism -1082 G/A (rs1800896) of the gene IL-10 in the formation of various molecular biological profiles of vaginal microbiocenosis in bacterial vaginosis. Materials and methods: 195 women of reproductive age were examined, including 100 patients with bacterial vaginosis and 95 conditionally healthy women with vaginal normocenosis. The state of vaginal microbiocenosis was assessed by microscopic and molecular biological methods. The polymorphism -1082 G/A (rs1800896) of the IL-10 gene was genotyped using polymerase chain reaction and detection of amplification products on an electrophoresis gel. Results: Genotype G/G was more common in women with the prevalence of obligate-anaerobic microorganisms in the microbiocenosis (21.2%, p=0.046), genotype G/A – in women with severe mixed dysbiosis (61.3%, p=0.023). In women with a predominance of facultative anaerobes Gardnerella vaginalis and Atopobium vaginae in the microbiocenosis, there was no significant difference in the distribution of genotypes (p&gt;0.05). Conclusion: The carriage of allelic variants -1082G (rs1800896) of the gene IL-10 is associated with deeper disorders of vaginal microbiocenosis, which suggests their use as markers that increase the effectiveness of the diagnosis of recurrent forms of bacterial vaginosis.

Reproductive healthcare seeking behaviour of women of the reproductive age group in an urban resettlement area of district Gautam Buddh Nagar in Uttar Pradesh, India.

Reproductive tract infections (RTIs) and gynaecological morbidities constitute a significant proportion of morbidities in women of the reproductive age group. To find out the proportion of reproductive age group women in an urban resettlement colony having the symptoms of gynaecological morbidities and RTI/sexually transmitted infection (STI) and to explore the healthcare seeking behaviour of the women during such ailments. A community-based cross-sectional study was conducted from January to June 2023 among 317 females aged 15 to 49 years in an urban resettlement area of Gautam Buddh Nagar district in Uttar Pradesh. Statistical analysis used included descriptive statistics and Chi-square test. SPSS 23 was used for data analysis. There was a prevalence of 65.3% of at least one self-reported symptom suggestive of RTI/STI or gynaecological morbidity among the respondents. Among the symptomatic respondents, 54.1% were found to seek treatment. Among the reasons given for not seeking treatment in any health facility, the majority (83.1%) responded 'lack of awareness that the problem needed medical treatment' and 'stigma related with the problem' to be the main reasons. The reproductive healthcare seeking behaviour was found to be inadequate, with only 54.1% of symptomatic respondents seeking treatment. Enhanced health awareness sessions can be planned in the short term, and skilled communicators within or outside of the health system in the long term may be deployed to disseminate information in the community regarding sexual and gynaecological morbidities in reproductive age group women and their timely intervention.

A Complete Overview of the Polycystic Ovarian Syndrome with Recent Advancement in Clinical Trial

Background: Polycystic ovarian syndrome (PCOS) has emerged as one of the most common endocrine and metabolic disorders seen in women of childbearing age throughout the whole world. The complex pathophysiology, different diagnostic criteria, and various manifestations attached to several environmental factors, including lifestyle influences, have made it one of the most difficult disorders to treat in recent times. In addition, inadequate knowledge among patients and a lack of dedicated approved medications have only enhanced the difficulties in treating such a heterogeneous disorder. Objective: The main objective of this review-type paper is to provide a detailed overview of PCOS along with the current concept of a clinical stance in this complex multigenic disorder. Method: The following databases were used for literature searches: PubMed, Frontiers, Science Direct, Springer, Wiley, and MDPI. For the purpose of finding pertinent articles and contents, the keywords “PCOS; hirsutism; psychological burden; obesity” and others of a similar nature were utilized. Conclusion: PCOS is a complicated hormonal, metabolic, and psychological condition with many different clinical manifestations. It is among the most prevalent causes of infertility. Before considering any medication choices, lifestyle modifications should be considered the primary therapeutic prescription for PCOS-related infertility. According to recent studies, PCOS does not affect the risk of ovarian or breast cancer, but it does raise the risk of endometrial cancer in women of all ages. These results suggest that PCOS may increase the risk of gynaecological cancer morbidity. The following stage is ovulation stimulation, which is best accomplished with letrozole and is followed by clomiphene citrate. Women who had not responded to the first-line oral ovulatory medicine were given gonadotropins as a backup. Early detection of girls with a high propensity to develop PCOS will be made possible by a comprehensive knowledge of the condition's etiology. Adolescent PCOS will be better managed overall, related comorbidities will be prevented, and quality of life will increase with customized therapeutic approaches.

ДИНАМИКА И СТРУКТУРА АБОРТОВ В РОССИЙСКОЙ ФЕДЕРАЦИИ И ДАЛЬНЕВОСТОЧНОМ ФЕДЕРАЛЬНОМ ОКРУГЕ В 2003-2022 ГОДАХ

Significance. A high medical and social significance of abortions is due to high prevalence and substantial contribution to reproductive loss, maternal mortality and gynecological morbidity, including infertility. The purpose of the study was to analyze dynamics and structure of abortions in the Russian Federation and Far Eastern Federal District and its regions in 2003-2022. Material and methods. The study analyzed official statistics data (Federal statistical observation Form No. 13 “Information about pregnancy termination (up to 28 weeks of gestation),” and “Information about pregnancy termination (up to 22 weeks of gestation) - for the period from April 2012, in the Russian Federation, Far Eastern Federal District and its regions in 2003-2022. Dynamic series indicators (ratio indicators, growth rate, rate of increase/decrease) were calculated, the methods of direct ranking, descriptive statistics were used. Results. In 2003-2022, there was a decrease in the number of all types of abortions in the Far Eastern Federal District, as well as in the Russian Federation as a whole – by 71.32% and 76.4%, respectively. At the same time, the absolute number of medical (legal) abortions has significantly decreased: by 80.6% (from 89,564 in 2003 to 17,376 in 2022) in the Far Eastern Federal District and by 86.7% (from 1349,652 to 179,387) in the Russian Federation. However, in the Far Eastern Federal District, as in the Russian Federation as a whole, the share of medical abortions in the structure of medical (legal) abortions increased from 0.02% to 44.0%, and the share of spontaneous abortions of the total number of abortions increased from 9.4% to 20.0%. Conclusion. In 2003-2022, the number of all types of abortions decreased in both the Far Eastern Federal District and the Russian Federation as a whole, however, their level remains high. The decrease in the number of abortions is accompanied by an unfavorable change in their structure, with the increasing share of spontaneous abortions as the main sign of reproductive system disfunction. Keeping in mind that miscarriage is the main cause of reproductive loss, prevention and successful treatment of this pathology is an actual reserve for increasing fertility.

Generation and Maintenance of Patient-Derived Endometrial Cancer Organoids.

Endometrial cancer (EC) is the leading cause of gynecologic cancer morbidity and mortality in the U.S. Despite advancements in cancer research, EC death rates are increasing, particularly high-grade endometrial cancers. The development of three-dimensional (3D) patient-derived organoid (PDO) models for EC is crucial, as they provide a more accurate representation of the biological and genetic complexity of a patient's tumor compared to traditional 2D cell lines. Here, we describe a protocol for cultivating PDO models from normal endometrium and EC across different EC subtypes. These EC PDO models can be expanded across multiple passages and facilitate the exploration of tumor behavior and drug responses, thereby advancing our understanding of the disease and potentially leading to more effective and individualized novel therapeutic strategies. Key features • Establishment of patient-derived EC and normal endometrium organoids. • Accurate replication of the various histologic and molecular subtypes of EC within the organoids. • Our approach provides a clinically relevant platform for studying EC development, metastasis, progression, and recurrence. • It offers potential for developing targeted therapeutic interventions tailored to specific EC subtypes. Graphical overview Schematic overview of endometrial cancer and normal organoid preparation from patient-derived samples.

Psychiatric Morbidity and Assessment of its Severity in Gynaecologic Oncology Patients: A Cross-sectional Study

Introduction: Several psychological and social factors influence the incidence, treatment, and outcome of cancer patients. Depressive symptoms are more common in cancer patients, particularly in late stages. Women in Indian settings often exhibit delayed treatment-seeking behaviour. Aim: To assess the prevalence, type, and severity of psychiatric morbidity as well as the duration, type, and stage of illness in gynaecological oncology patients. Materials and Methods: This cross-sectional study was conducted among 100 gynaecological oncology patients aged 18 to 65 years, who were attending the gynaecologic Outpatient Department (OPD) and ward at a tertiary care hospital. The study took place at Government Rajaji Hospital, Madurai, between May 2013 and November 2013. Data was collected using a semistructured questionnaire from the patient and a reliable informant, after obtaining informed consent. The data was entered into Microsoft Excel and analysed using Statistical Package for Social Sciences (SPSS) software version 20.0. Central values, dispersion, and Chi-square tests were calculated. Results: The sample comprised 100 gynaecological oncology patients, with 30 (30%) diagnosed with malignancy, 43 (43%) with a benign condition, and 27 (27%) under investigation. Among the 100 patients assessed, 34 (34%) had psychiatric morbidity. There was a significantly higher prevalence among older patients, those with more than six months’ duration of gynaecological morbidity, and those exhibiting non fatal suicidal behaviour. Conclusion: Psychiatric morbidity is highly prevalent in gynaecological oncology patients. Depression was found to be more frequent and severe in patients with cancer. A previous history of suicidal attempts and a family history of psychiatric illness are important predictors of psychiatric morbidity in this population. Future studies on a larger population should explore the biological relationship between gynaecological oncology and psychiatric illness.

Endometrial hyperplastic processes: modern approaches to diagnosis and treatment

An issue of endometrial hyperplastic processes in the reproductive period is one of the pressing problems of gynecology due to their high prevalence in this age group. The continuing interest in this issue is determined by the data that endometrial hyperplastic processes tend to have a long, relapsing course, the lack of specific, pathognomonic symptoms as well as the complexity in differential diagnosis and choice of methods for prevention and treatment. Unfortunately, the problem of treating such patients remains far from being solved, which dictates a need to optimize patient management tactics, which should be aimed not only at creating proper integrated approaches to predicting development and recurrence of endometrial hyperplastic processes, but also developing a differentiated approach to management patients with this pathology in order to reduce gynecological and oncological morbidity as well as increase reproductive potential in this patient cohort.

Ендокринна і гінекологічна захворюваність у жінок із непліддям та посттравматичним стресовим розладом

Post-traumatic stress disorder is a complex of mental symptoms of an anxious, obsessive and avoidant nature that persist for more than 6 months after the impact of the traumatic factor. Purpose - to study the reproductive history of patients with infertility and post-traumatic stress disorder to improve preparation to additional reproductive technologies use. Materials and methods. The study analyzed the reproductive anamnesis, gynecological and endocrine morbidity of 67 patients with infertility, who were divided into 2 groups: the Group I - 36 women with impaired fertility before the action of a traumatic factor, the Group II - 31 women with infertility due to stress disorder The Comparison group consisted of 45 women with infertility without symptoms of post-traumatic stress disorder, the Control group - 30 healthy women. Results. The patients of the Group I had mostly primary infertility (80.5%), in the Group II, the vast majority of women had pregnancies and deliveries. 44.4% of women in the first group had a duration of infertility of 5 years or more, in the Group II 64.1% - up to 3 years. In the Group I, patients were characterized by late menarche (22.2%, in the Group II - 6.5%), uterine bleeding during adolescence (33.3%) and reproductive (27.8%) periods (in the Group II - 9.7% and 12,9%, respectively). Patients of the Group I more often had accompanying diabetes (33.3%; in the Group II - 16.2%), obesity (38.9%; in the Group II - 29.0%), hyperandrogenemia (27.8%; in the Group II - 16.2%). Every third patient with infertility and post-traumatic stress disorder had an increased concentration of prolactin. Conclusions. Post-traumatic stress disorder is a powerful factor of impaired fertility, because in the group of women with infertility registered after a traumatic factor, the previous history was uncomplicated (the vast majority of them had given birth - 77.5%), the frequency of endocrine disorders corresponds to the indicator of healthy women (carbohydrate metabolism disorders - 16.2% and 20.2%, respectively), obesity (29.0% and 23.3%, respectively), hyperandrogenemia (16.2% and 13.3%, respectively). Patients with post-traumatic stress disorder, who had infertility before the impact of the traumatic factor, mostly had the primary form of fertility disorder (80.5%), late menarche (22.2%; in the Control group - 6.6%), juvenile (33.3%; in the Control group - 6.6%) and abnormal uterine bleeding in the reproductive period (27.8%; in the Control group - 10%). Endocrine disorders were also more common in this group - carbohydrate metabolism disorders (33.3%), obesity (38.9%), hyperandrogenemia (27.8%). The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Reproductive health and reproductive behavior of adolescent girls in Tofalaria

BACKGROUND: The reproductive potential of adolescent girls includes several parameters, such as general and gynecological morbidity, physical and sexual development, psychosocial readiness for partnership and motherhood. Therefore, it is crucial to consider these parameters when assessing the reproductive capacity of adolescent girls in different settings.&#x0D; AIM: To study the reproductive health and reproductive behavior of girls residing in Tofalaria.&#x0D; MATERIAL AND METHODS: A total of 194 girls participated in the study, with 58 of them being Tofalars. These girls were aged between 11 and 17 years old and resided in the Nizhneudinsk district of the Irkutsk region. The study involved analyzing medical records, conducting examinations by an obstetrician-gynecologist, collecting clinical samples from the urogenital tract for microscopy to detect transmitted infections, and performing colposcopy.&#x0D; RESULTS: The average age of onset of menarche among the study participants was between 11.5 and 12.0 years. Tofalar girls were more likely to experience menstrual cycle disorders such as oligomenorrhea and abnormal uterine bleeding. Additionally, delayed puberty was more commonly observed among Tofalar girls. Reproductive behavior of the Tofalar girls was characterized by early engagement in relationships, promiscuity, high prevalence of sexually transmitted infections, and high proportion of unplanned pregnancies.&#x0D; CONCLUSION: There is a need to develop and implement a long-term strategy on preserving the reproductive health of adolescents and young people in the Irkutsk region through consolidating the efforts of civil society institutions and governmental agencies at both regional and municipal levels.

Features of the course of pregnancy and health of newborns with intrauterine growth restriction

Introduction. The development of intrauterine growth restriction (IUGR) begins with fertilization and trophoblast invasion. IUGR is manifested in a decrease in fetal growth rate. However, data on risk factors for fetal growth retardation, their combination with various chronic diseases in a pregnant woman are contradictory.Objective. To study the features of the course of pregnancy, childbirth, the health status of newborns with IUGR. Materials and methods. The study was a retrospective cohort study. At the first stage, we analyzed 1574 birth histories with a diagnosis of IUGR, placental insufficiency, women with normal pregnancy who gave birth (2016–2021). According to the inclusion and exclusion criteria, 408 women were included in the study. The women were divided into 2 groups. The first group included 202 pregnant women with a diagnosis of IUGR. In the second Group – 206 pregnant women with normal pregnancy, without IUGR, delivered at the time corresponding to the terms in the main group.Results. We have clarified the risk factors and premorbid conditions involved in the development of IUGR (somatic and gynecological morbidity, pregnancy course). Their analysis is necessary to predict IUGR. The analysis of the timing and method of delivery in the studied groups was carried out. A higher incidence of complications in the early neonatal period was revealed when assessing the health status of newborns with IUGR.Conclusion. Thus, the study of the mechanisms of IUGR formation in the future will allow the development of modern pathogenetic approaches to prevention and treatment.

Reproductive outcome and gynecologic comorbidities in women with endometriosis in a non-IVF setting: a retrospective study

BackgroundEndometriosis-related infertility is a disease associated with significant morbidity and distress to the couple and requires timely, multidisciplinary, and often high-cost care involving assisted reproductive technologies (ART). Many health care systems in the Middle East do not provide coverage for ART. This study aims to describe the reproductive outcome in a form of a clinical pregnancy rate in women with endometriosis-related infertility in a health care system that does not provide coverage for ART.ResultsThis is a retrospective observational cohort study on women who attended the gynecology clinic in a tertiary center in Oman with the diagnosis of endometriosis from January 2011 to December 2019. Women of reproductive age seeking pregnancy were included in the analysis. Out of total women with endometriosis, (144/262) 55.0% were included in the analysis with a mean age of 31.10 ± 5.73 years. The mean duration of follow-up was 30.18 months and 43/144 (29.9%) of our patients had a follow-up > 60 months. Based on surgical staging, 11.8% had mild disease, 70.1% had moderate to severe disease and 18.1% were not operated. After a thorough assessment, (30.2%) were advised to seek in vitro fertilization (IVF) as a primary treatment for infertility but 23.08% declined the advice. Of the 144, 24.3% achieved a clinical pregnancy. (16/144), 11% conceived spontaneously. 11/144) 7.6% conceived with ovulation induction ± intrauterine insemination (OI ± IUI) and the rest conceived with a self-sponsored IVF. The overall clinical pregnancy rate was not statistically different between those who had surgery and those did not have surgery (P value 0.474). The pregnancy rate based on the management plan were; surgery + IVF (7/25, 28.0%), surgery + OI/IUI (10/47, 21.3%), surgery alone (9/33, 27.3%). The pregnancy rate was not statistically different between the groups (P value 0.782).In addition to endometriosis, a significant proportion (63/144, 43.8%) of these women have a coexisting gynecologic morbidity including 2.1% non-endometrioma ovarian cyst, 13.9% myomas, 4.2% adenomyosis, 8.3% Mullerian anomalies, 2.1% polycystic ovary syndrome, 6.3% pelvic inflammatory disease or tubo-ovarian abscess and 1.4% biopsy-proven endometritis.ConclusionThe reproductive outcome of patients with endometriosis in this study population was generally poorer than what is reported in the literature with an overall pregnancy rate of 24.3% and a spontaneous pregnancy rate of 11%. Several causes can be noted for such an outcome, including advanced disease stage, coexisting gynecologic morbidities, and poor access to advance fertility management.

The role of stress reactions in the genesis of menstrual cycle disorders in recurrent urinary tract infections in minors

BACKGROUND. Extragenital diseases, including recurrent urinary tract infections, have an adverse effect on the reproductive health of children and adolescents. Vaginitis and menstrual cycle disorders, including primary oligomenorrhea, predominate in the structure of gynecological morbidity of minors suffering from recurrent UTIs.THE AIM: to study the role of stress reactions in the genesis of various variants of menstrual cycle disorders in minors suffering from recurrent UTIs to improve the dispensary management of this cohort of patients. PATIENTS AND METHODS. A prospective study was conducted in 98 adolescent girls aged 16 to 18 years. Taking into account the nature of the clinical course of UTI, all the subjects were divided into 3 groups: group 1 (n=41) – patients with UTI; group 2 (n=27) patients with frequent recurrence of UTI (more than 3 times a year (rIMP); group 3 (n=30) – minors, 1, 2 health groups with no IPM episode. A specialized gynecological examination, functional diagnostic tests, ultrasound examination of the placemark and ovaries, determination of cortisol, norepinephrine, adrenaline by enzyme immunoassay were carried out. Statistical analysis was performed using the program "SPSS Statistics 17.0 for Windows".RESULTS. Anovulation was observed in patients with frequent recurrence of UTI. Copious and prolonged menstruation, uterine bleeding and primary oligomenorrhea were observed only in patients with recurrent UTIs. In this cohort, inflammatory gynecological diseases take a chronic course. Polycystic ovarian syndrome (40.7 %) and chronic salpingoophoritis (44.4 %) were often detected in patients with frequently recurrent UTI. In patients suffering from UTI, in contrast to the data of the comparison group, there were significant violations of the nature of adaptive reactions, and changes in antistress reactions and their levels differed depending on the variant of the course of the microbial-inflammatory process. In patients with rare relapses of UTI, antistress reactions of a high level of reactivity prevailed, but there were reactions of calm and increased activation, training that took place at low levels of reactivity.CONCLUSION. Adaptive-compensatory disorders were revealed in almost every patient with recurrent UTI. Considering that stress is especially pathogenic during puberty, when hormonal and psychophysiological restructuring of the body occurs, prevention and complex therapy of microbial-inflammatory diseases of the urinary system in this category of patients should be carried out taking into account the formation of reproductive function and the severity of adaptation reactions.