Pub Date : 2023-06-30DOI: 10.18370/2309-4117.2023.68.76-83
Emergency contraception (EC) refers to several contraceptive options that can be used within a few days after unprotected or under protected intercourse or sexual assault to reduce the risk of pregnancy. Current EC options available in the United States include the copper intrauterine device (IUD), levonorgestrel (LNG) 52 mg IUD, oral LNG, and oral ulipristal acetate (UPА).
These clinical recommendations review the indications, effectiveness, safety, and side effects of emergency contraceptive methods; considerations for the use of EC by specific patient populations and in specific clinical circumstances and current barriers to emergency contraceptive access. Further research is needed to evaluate the effectiveness of LNG IUDs for emergency contraceptive use; address the effects of repeated use of UPА at different times in the same menstrual cycle; assess the impact on ovulation of initiating or reinitiating different regimens of regular hormonal contraception following UPА use; and elucidate effective emergency contraceptive pill options by body mass indices or weight.
{"title":"Emergency contraception: society of family planning clinical recommendation (2023)","authors":"","doi":"10.18370/2309-4117.2023.68.76-83","DOIUrl":"https://doi.org/10.18370/2309-4117.2023.68.76-83","url":null,"abstract":"Emergency contraception (EC) refers to several contraceptive options that can be used within a few days after unprotected or under protected intercourse or sexual assault to reduce the risk of pregnancy. Current EC options available in the United States include the copper intrauterine device (IUD), levonorgestrel (LNG) 52 mg IUD, oral LNG, and oral ulipristal acetate (UPА).
 These clinical recommendations review the indications, effectiveness, safety, and side effects of emergency contraceptive methods; considerations for the use of EC by specific patient populations and in specific clinical circumstances and current barriers to emergency contraceptive access. Further research is needed to evaluate the effectiveness of LNG IUDs for emergency contraceptive use; address the effects of repeated use of UPА at different times in the same menstrual cycle; assess the impact on ovulation of initiating or reinitiating different regimens of regular hormonal contraception following UPА use; and elucidate effective emergency contraceptive pill options by body mass indices or weight.","PeriodicalId":21103,"journal":{"name":"Reproductive Endocrinology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136368856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Research objectives: to study the pathogenetic links in the development of stress urinary incontinence (SUI) by determining the state of connective tissue (CT), concentrations of trace elements, vitamins and estradiol in premenopausal women.Materials and methods. 189 women aged 45–55 years with SUI were examined. In addition to general clinical examination, concentrations of Total PІNP (type I collagen synthesis marker) and Total PІІІNP (type III collagen synthesis marker) and CT resorption marker Pyriliks-D, ionized magnesium, ionized calcium, total calcium, vitamins D and C, estradiol were studied in the blood serum in order to determine the state of fibrous CT.Results. In the structure of somatic morbidity were conditions defined as phenotypic manifestations of CT undifferentiated dysplasia. A decrease of the Total PІNP by 24.9% was found against the background of an increased Total PІІІNP by 46.7% and an increased Pyriliks-D by 54.1%. Women with SUI were characterized by a significant decrease in the average value of Mg2+ by an average of 16.7%, as well as a significant increase in the average value of Ca2+ by 5.3% and total Ca by 3.9%. The vitamin balance study shows a significant decrease of vitamin D by 40.6% and vitamin C by 37.0%. Estradiol concentration was at the minimum values of the physiological norm.Conclusions. Women in premenopausal age with SUI are characterized by a violation of the CT synthesis and resorption, which are realized by reducing the formation of the Total PІNP against the background of intensification of the Total PІІІNP and Pyriliks-D synthesis, combined with a disbalance of vitamins and trace elements. These features are highly likely to be considered as predictors of the SUI development in women of premenopausal age
{"title":"The role of connective tissue metabolism disorders in the genesis of stress urinary incontinence in premenopausal women","authors":"V.O. Beniuk, M.S. Puchko, Y.H. Drupp, T.R. Nykoniuk, V.F. Oleshko, A.A. Momot, T.V. Kovaliuk","doi":"10.18370/2309-4117.2023.68.89-93","DOIUrl":"https://doi.org/10.18370/2309-4117.2023.68.89-93","url":null,"abstract":"Research objectives: to study the pathogenetic links in the development of stress urinary incontinence (SUI) by determining the state of connective tissue (CT), concentrations of trace elements, vitamins and estradiol in premenopausal women.Materials and methods. 189 women aged 45–55 years with SUI were examined. In addition to general clinical examination, concentrations of Total PІNP (type I collagen synthesis marker) and Total PІІІNP (type III collagen synthesis marker) and CT resorption marker Pyriliks-D, ionized magnesium, ionized calcium, total calcium, vitamins D and C, estradiol were studied in the blood serum in order to determine the state of fibrous CT.Results. In the structure of somatic morbidity were conditions defined as phenotypic manifestations of CT undifferentiated dysplasia. A decrease of the Total PІNP by 24.9% was found against the background of an increased Total PІІІNP by 46.7% and an increased Pyriliks-D by 54.1%. Women with SUI were characterized by a significant decrease in the average value of Mg2+ by an average of 16.7%, as well as a significant increase in the average value of Ca2+ by 5.3% and total Ca by 3.9%. The vitamin balance study shows a significant decrease of vitamin D by 40.6% and vitamin C by 37.0%. Estradiol concentration was at the minimum values of the physiological norm.Conclusions. Women in premenopausal age with SUI are characterized by a violation of the CT synthesis and resorption, which are realized by reducing the formation of the Total PІNP against the background of intensification of the Total PІІІNP and Pyriliks-D synthesis, combined with a disbalance of vitamins and trace elements. These features are highly likely to be considered as predictors of the SUI development in women of premenopausal age","PeriodicalId":21103,"journal":{"name":"Reproductive Endocrinology","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136368852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Research objectives: to study age-related changes in the structure of vaginal tissues in women with pelvic prolapse (PP).Materials and methods. The structure of the vaginal wall was studied in 29 women with PP, who were divided into three groups: the first group – 11 women aged of 45 in the reproductive period with regular menstrual function; the second group – 8 women aged 45–55 in perimenopause with irregular menstrual function; the third group – 10 women aged 55–65 who have been postmenopausal for more than three years.All women underwent immunohistochemical detection of the CD34 marker and vascular endothelial growth factor (VEGF), podoplanin, the number of estrogen receptors, type 1 matrix metalloproteinase (type 1 collagenase) and type 1 collagen were determined.Results. The reproductive age was characterized by an active metabolism, which was reflected in the fullness of all vaginal layers, their thickening, heterochromia of the nuclei, increased metabolism in the connective tissue and synthesis of vasculogenesis stimulators. The expression of estrogen receptors was not increased due to a sufficient concentration of estrogens in the body.Atrophic changes in the perimenopausal age were determined as the thinning of the vaginal layers, sclerotic changes, and a decrease in protein synthesis in the form of nuclear hyperchromia. The number of estrogen receptors was compensatory increased due to their deficiency. A feature of this age is vascular imbalance, which was subjectively expressed in climacteric symptoms.Atrophic and sclerotic changes were observed in the postmenopausal period in the form of thinning of the vaginal wall, hyperchromia of the nuclei, an increase in the collagen level relative to an unchanged collagenase level, a decrease in lymphatic drainage, and an increase in the number of estrogen receptors.Conclusions. This study shows that all groups of women with PP have characteristic signs associated with age changes, features of the mestral cycle and hormonal saturation of the body. Factors affecting the PP development include: in reproductive age – increased collagenase activity, in perimenopause and postmenopause – atrophic dyshormonal and dyscirculatory processes in tissues.
{"title":"Immunohistochemical age changes of vagina tissues in women with pelvic prolaps","authors":"R.A. Safonov, V.Y. Prokopiuk, O.V. Hryshchenko, O.S. Prokopiuk, V.V. Lazurenko, M.H. Hryshchenko, V.Y. Parashchuk","doi":"10.18370/2309-4117.2023.68.84-88","DOIUrl":"https://doi.org/10.18370/2309-4117.2023.68.84-88","url":null,"abstract":"Research objectives: to study age-related changes in the structure of vaginal tissues in women with pelvic prolapse (PP).Materials and methods. The structure of the vaginal wall was studied in 29 women with PP, who were divided into three groups: the first group – 11 women aged of 45 in the reproductive period with regular menstrual function; the second group – 8 women aged 45–55 in perimenopause with irregular menstrual function; the third group – 10 women aged 55–65 who have been postmenopausal for more than three years.All women underwent immunohistochemical detection of the CD34 marker and vascular endothelial growth factor (VEGF), podoplanin, the number of estrogen receptors, type 1 matrix metalloproteinase (type 1 collagenase) and type 1 collagen were determined.Results. The reproductive age was characterized by an active metabolism, which was reflected in the fullness of all vaginal layers, their thickening, heterochromia of the nuclei, increased metabolism in the connective tissue and synthesis of vasculogenesis stimulators. The expression of estrogen receptors was not increased due to a sufficient concentration of estrogens in the body.Atrophic changes in the perimenopausal age were determined as the thinning of the vaginal layers, sclerotic changes, and a decrease in protein synthesis in the form of nuclear hyperchromia. The number of estrogen receptors was compensatory increased due to their deficiency. A feature of this age is vascular imbalance, which was subjectively expressed in climacteric symptoms.Atrophic and sclerotic changes were observed in the postmenopausal period in the form of thinning of the vaginal wall, hyperchromia of the nuclei, an increase in the collagen level relative to an unchanged collagenase level, a decrease in lymphatic drainage, and an increase in the number of estrogen receptors.Conclusions. This study shows that all groups of women with PP have characteristic signs associated with age changes, features of the mestral cycle and hormonal saturation of the body. Factors affecting the PP development include: in reproductive age – increased collagenase activity, in perimenopause and postmenopause – atrophic dyshormonal and dyscirculatory processes in tissues.","PeriodicalId":21103,"journal":{"name":"Reproductive Endocrinology","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136368857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-30DOI: 10.18370/2309-4117.2023.68.44-47
V.V. Kaminskyi, A.V. Serbeniuk, Y.O. Kumpanenko
Background. The mirror of a female’s reproductive health is the menstrual cycle. The SARS-CoV-2 pandemic itself acts as a significant stressor. This leads to women’s overall health and life quality disturbance. Moreover, patients struggle with long COVID effects, which is a prolongation of symptoms after recovery. Due to the expression of angiotensin-converting enzyme type 2 receptors in the intestinal mucosa and inflammation, the gastrointestinal (GI) tract is also triggered by the virus.Objectives. To assess the efficacy of the chosen treatment approach in women with changes in premenstrual syndrome and cyclicity due to long COVID with or without GI symptoms.Material and methods. A single-centre longitudinal interventional study was organized. Were studied data from the conducted tests (progesterone level, ultrasound follicle scan, etc.) and surveys. Then the effectiveness of the suggested treatment with the use of oral and vaginal forms of progesterone was evaluated. The study was held in the Kyiv City Center of Reproductive and Perinatal Medicine (Ukraine) from January to June 2021.Results. On average 78% patients without GI symptoms experienced relief after 3 months and 89% patients after 6 months of suggested treatment. 71% patients with GI symptoms experienced improvement after 3 and 87% of them after 6 months. The vaginal progesterone had better results compared to oral form. Averagely 6–8% experienced side effects (nausea, hypotension, less compliance) due to progesterone intake. The vaginal micronised progesterone also presented better results than oral with fewer side effects compared to the total number of participants.Conclusions. The proposed approach has shown particular correction of the menstrual cycle disturbances in women with long COVID. Vaginal micronized progesterone offers more promising outcomes in patients with GI symptoms and disrupted absorption, compared to the oral form.Further investigation is required for a more reasonable conclusion.
{"title":"Approaches towards menstrual cycle disorder therapy in reproductive-aged women with long COVID","authors":"V.V. Kaminskyi, A.V. Serbeniuk, Y.O. Kumpanenko","doi":"10.18370/2309-4117.2023.68.44-47","DOIUrl":"https://doi.org/10.18370/2309-4117.2023.68.44-47","url":null,"abstract":"Background. The mirror of a female’s reproductive health is the menstrual cycle. The SARS-CoV-2 pandemic itself acts as a significant stressor. This leads to women’s overall health and life quality disturbance. Moreover, patients struggle with long COVID effects, which is a prolongation of symptoms after recovery. Due to the expression of angiotensin-converting enzyme type 2 receptors in the intestinal mucosa and inflammation, the gastrointestinal (GI) tract is also triggered by the virus.Objectives. To assess the efficacy of the chosen treatment approach in women with changes in premenstrual syndrome and cyclicity due to long COVID with or without GI symptoms.Material and methods. A single-centre longitudinal interventional study was organized. Were studied data from the conducted tests (progesterone level, ultrasound follicle scan, etc.) and surveys. Then the effectiveness of the suggested treatment with the use of oral and vaginal forms of progesterone was evaluated. The study was held in the Kyiv City Center of Reproductive and Perinatal Medicine (Ukraine) from January to June 2021.Results. On average 78% patients without GI symptoms experienced relief after 3 months and 89% patients after 6 months of suggested treatment. 71% patients with GI symptoms experienced improvement after 3 and 87% of them after 6 months. The vaginal progesterone had better results compared to oral form. Averagely 6–8% experienced side effects (nausea, hypotension, less compliance) due to progesterone intake. The vaginal micronised progesterone also presented better results than oral with fewer side effects compared to the total number of participants.Conclusions. The proposed approach has shown particular correction of the menstrual cycle disturbances in women with long COVID. Vaginal micronized progesterone offers more promising outcomes in patients with GI symptoms and disrupted absorption, compared to the oral form.Further investigation is required for a more reasonable conclusion.","PeriodicalId":21103,"journal":{"name":"Reproductive Endocrinology","volume":"166 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136368855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Miscarriage remains an important global problem: 23 million miscarriages are registered annually in the world, i.e. 44 pregnancy losses every minute, and the total risk of miscarriage is 15.3% of all pregnancies. Effective methods of pregnancy preservation (in case of idiopathic miscarriage and threatened miscarriage) include lifestyle modification and progestagen therapy. Progesterone is the main hormone necessary to maintain pregnancy.The effectiveness of progestogens among medical methods that increase the chances of pregnancy preservation has been proven by numerous studies. Effectiveness and safety of various types of progestogens during pregnancy have been studied. As a result, progesterone and dydrogesterone became the only progestogens approved for use in obstetrics – micronized progesterone and dydrogesterone reduce the frequency of miscarriage in women with clinical diagnoses of threatened miscarriage and idiopathic recurrent miscarriage. In addition, the progestogens safety has been carefully studied in modern randomized studies, prospective trials and meta-analyses and the same safety profile of dydrogesterone and micronized progesterone for pregnant women and the fetus has been proven.Studies have shown that oral dydrogesterone has relatively low antagonistic activity at glucocorticoid and mineralocorticoid receptors compared to progesterone and therefore well tolerated. Oral dydrogesterone due to the peculiarities of structure has improved bioavailability compared to progesterone, which allows a woman to avoid the inconvenience and discomfort associated with the intravaginal or intramuscular use of progesterone. In addition, dydrogesterone has a 1.5 times higher affinity for progesterone receptors compared to micronized progesterone and a pronounced anti-inflammatory and immunomodulation effect, which provides certain clinical advantages for patients after recurrent pregnancy losses.Thus, progestogens are indicated for all patients with recurrent pregnancy losses from the moment of receiving a positive pregnancy test, as they reduce the risk of miscarriage. It is important that the use of progestagen drugs during the first and second trimester of pregnancy is not associated with side effects
{"title":"Progestagens in high-risk pregnancy. What we know today","authors":"N.Y. Pedachenko, N.P. Goncharuk, E.F. Chaikivska, T.F. Tatarchuk, T.M. Tutchenko","doi":"10.18370/2309-4117.2023.68.22-28","DOIUrl":"https://doi.org/10.18370/2309-4117.2023.68.22-28","url":null,"abstract":"Miscarriage remains an important global problem: 23 million miscarriages are registered annually in the world, i.e. 44 pregnancy losses every minute, and the total risk of miscarriage is 15.3% of all pregnancies. Effective methods of pregnancy preservation (in case of idiopathic miscarriage and threatened miscarriage) include lifestyle modification and progestagen therapy. Progesterone is the main hormone necessary to maintain pregnancy.The effectiveness of progestogens among medical methods that increase the chances of pregnancy preservation has been proven by numerous studies. Effectiveness and safety of various types of progestogens during pregnancy have been studied. As a result, progesterone and dydrogesterone became the only progestogens approved for use in obstetrics – micronized progesterone and dydrogesterone reduce the frequency of miscarriage in women with clinical diagnoses of threatened miscarriage and idiopathic recurrent miscarriage. In addition, the progestogens safety has been carefully studied in modern randomized studies, prospective trials and meta-analyses and the same safety profile of dydrogesterone and micronized progesterone for pregnant women and the fetus has been proven.Studies have shown that oral dydrogesterone has relatively low antagonistic activity at glucocorticoid and mineralocorticoid receptors compared to progesterone and therefore well tolerated. Oral dydrogesterone due to the peculiarities of structure has improved bioavailability compared to progesterone, which allows a woman to avoid the inconvenience and discomfort associated with the intravaginal or intramuscular use of progesterone. In addition, dydrogesterone has a 1.5 times higher affinity for progesterone receptors compared to micronized progesterone and a pronounced anti-inflammatory and immunomodulation effect, which provides certain clinical advantages for patients after recurrent pregnancy losses.Thus, progestogens are indicated for all patients with recurrent pregnancy losses from the moment of receiving a positive pregnancy test, as they reduce the risk of miscarriage. It is important that the use of progestagen drugs during the first and second trimester of pregnancy is not associated with side effects","PeriodicalId":21103,"journal":{"name":"Reproductive Endocrinology","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136368976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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