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

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The assessment of nutrition status, anthropometry, eating disorders, fat tissue and leptin levels in 48 patients with functional hypothalamic amenorrhea (FHA) was conducted. The study of nutrition status revealed a discrepancy between the caloric intake and energy expenditure in 50% of patients, inadequate daily intake of carbohydrates in 91.7%, increased protein intake in 70.8% of patients. The recommended ratio of proteins, fats, carbohydrates in patients of the study group was not observed (1:1:0.3). It was noted that the deficit of adipose tissue and the decrease in serum leptin concentration were observed not only in patients with low body mass index), but also in 70% of women with normal values. Using the questionnaire Eating Disorder Inventory 2 (EDI-2) revealed that 54.2% of patients had drive for thinness and 22.9% of patients had body dissatisfaction. The results indicate the need for an integrated approach to the management of patients with FHA, which provides consultation of a gynecologist, psychotherapist and nutritionist.

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OBJECTIVE: Estimation of microbiocenosis of lower and upper genital tract in different morphological forms of chronic endometritis and endometrial polyps. MATERIAL AND METHODS: Histological examination of endometrial aspirates and microview of the lower and upper genital tract in 164 women of reproductive age with different character of menstrual and reproductive history. RESULTS: The risk of endometrial colonization in, disturbance microecology of the vagina is 3.5 times higher than that, in patients with normosenosis (p<0.01, OP=3.5 [95%. CI 1.63-8.11]). CONCLUSION: The microbiological diagnosis can be considered as a component of comprehensive diagnostics necessary to choose the appropriate management of patients with CE and PE.

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We studied local expression of insulin-like growth factor 1, insulin-like growth factor receptor, epithelial growth factor, transforming growth factor beta2, PCNA, TNF-alpha, type I TNF receptor, Fas, FasL, IFN-gamma, IL-1beta, IL-4, IL-6, IL-8, IL-10, and IL-12 genes in intact and hyperplastic endometrium. Endometrial hyperplasia was associated with reduced production of TNF-alpha (p<0.05), PCNA (p<0.05), and epithelial growth factor mRNA and enhanced production of Fas mRNA (p<0.01). The expression of TNF-R1, IL-1beta, and IL-12 genes decreased only in glandular cystic hyperplasia (p<0.05 for all genes), expression of insulin-like growth factor 1 gene decreased only in adenomatous hyperplasia (p<0.05). Dufaston therapy of glandular cystic hyperplasia and zoladex therapy of adenomatous hyperplasia normalized expression of Fas receptor, PCNA, and insulin-like growth factor 1 genes, while the expression of IFN-gamma and IL-6 genes, which was normal in hyperplasia, decreased (p<0.05). Zoladex therapy decreased the production of transforming growth factor beta2 (p<0.05) and IL-1beta (p<0.01) mRNA, dufaston therapy decreased production of TNF-alpha (p<0.05) and IL-4 mRNA (p<0.05). Hence, both apoptosis and proliferative activity were suppressed in endometrial hyperplasia, and hormone therapy created prerequisites for transition of the endometrium into the normal proliferation stage.

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Correlations between local expression of insulin-like growth factor 1, insulin-like growth factor receptor, epithelial growth factor, transforming growth beta2 factor, PCNA, TNF-alpha, TNF receptor 1, Fas, FasL, IFN-gamma, IL-1beta, IL-4, IL-6, IL-8, IL-10, and IL-12 genes in intact and hyperplastic endometrium and in the endometrium after hormone therapy were analyzed. Numerous correlations at the proliferation and secretion stages of the menstrual cycle indicate balanced cytokine system. The number of correlations decreases in glandular cystic and more so in atypical hyperplasia, indicating imbalance in the cytokine system. Dufastone and zoladex therapy did not lead to recovery of this balance, but higher correlations between the expression of some factors of cell proliferation attest to the beginning of normalization of pathologically changed endometrium.

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The effect of metformin has been studied among 42 patients of reproductive age with polycystic ovary syndrome. Therapy for 6-months was associated with regular menstrual cycle in 54.3% women, (ovulation was observed in 28.6%). After therapy 19.1% patients became pregnant. Serum levels LH fell from 16.3+/-1.45 to 8.9+/-0.82 IU/l, T from 3.3+/-0.17 to 2.0+/-0.17 nmol/l, (p<0.01). We noted increase of GH from 2.7+/-0.98 to 9.0+/-1.91 nmol/l and SHBG from 36.4+/-2.6 to 58.2+/-4.11 nmol/l, (p<0.01). After therapy we observed decrease of insulin responses during oral glucose tolerance test, (p<0.05).

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Patients of a reproductive age suffering from relapsing hyperplastic processes and adenomatosis of the endometrium were treated with tamoxifen, an antiestrogen. Time course of sex steroid hormones, steroid-binding globulin, and estrogen receptors in endometrial tissue was monitored over the course of therapy. A three-month course resulted in adenomatosis disappearance in more than 90% of patients. Tamoxifen antiestrogenic effect is realized both at the expense of blocking endometrial estrogen receptors which is indicated by their reduced number and by enhanced binding of sex hormone free fractions at the expense of increased synthesis of steroid-binding globulin under the effect of tamoxifen.

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Brain hemodynamics was studied in 76 patients with oligomenorrhea aged 18 to 35 from the data of rheoencephalography. Disorders of the regional tone of brain vessels were different and related to the time of the menstrual cycle disorder; this may be explained by the degree of changes in various neuromediator mechanisms of brain circulation and reproductive system function regulation.

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Analysis of the clinical picture of oligomenorrhea and of the results of studies of the function of various sections of the autonomic nervous system (ANS) in 58 patients of a reproductive age has revealed differences in these functions, related to the time of menstrual disorders onset. Oligomenorrhea patients with menarche complained of cardiovascular, respiratory, and emotional-motivational disorders, examinations have revealed in them dysfunctional disorders and reduced reserve potentials of both ANS sections. In oligomenorrhea patients in whom the condition developed at the age of 18-25 after a period of regular menstruations the effects of various stress factors resulted in reduction of the functional activity of the ergotropic (sympathoadrenal) section of the ANS. Differences in the pathogenetic mechanisms of oligomenorrhea development in the two groups of patients are discussed.

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The evidence obtained supports referring women with ovarian amenorrhea and gonadal dysgenesis to a high-risk group for atherosclerosis and cardiovascular diseases. This fact dictates inclusion of the diagnosis of atherogenic dyslipoproteinemia into the complex of check-up measures for women with early nonoperative ovarian amenorrhea as well as prophylaxis of cardiovascular disorders.

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A study of serum lipids in 68 women with ovarian forms of amenorrhea has documented prominent lipid abnormalities in most women with ovarian dystrophy and gonadal dysgenesis. It presented as elevation of cholesterol, triglyceride, low density lipoprotein cholesterol levels and a decrease in high density lipoprotein cholesterol levels, with Types IV and IIb dyslipoproteinemia. These findings suggest that the women with ovarian dystrophy and gonadal dysgenesis are at a high risk of early onset of atherosclerosis and cardiovascular diseases.

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