In women during perimenopause, changes in metabolic parameters are detected, such as weight gain, which triggers a cascade of pathological reactions leading to the formation of metabolic disorders (lipid, carbohydrate metabolism) and endothelial dysfunction, during the development of which a deficiency of sex hormones plays a certain role in the onset of menopause. There is a connection between hormonal changes and an increase in the amount of abdominal and/or visceral fat, which is accompanied by a weakening of oxidative processes in adipose tissue, a decrease in energy consumption and a predisposition to the development of metabolic syndrome. As a nutritional correction, it is advisable to introduce into the diet lipotropic substances that help catalyze the breakdown of fats and ensure the processes of hydroxylation and methylation of toxic substances in the liver, such as methionine, inositol and choline. Each of the lipotropic substances affects the mobilization of fats, and their combination can provide a synergistic effect and increase the natural metabolic function of the liver.

Endometriosis remains one of the most mysterious and controversial diseases in modern gynecology. Contemporary statistical data demonstrate the extreme relevance of actively implementing effective therapeutic approaches into the clinician’s everyday practice. However, a significant challenge associated with endometriosis is the pain syndrome. The question of so-called atypical algological manifestations of endometriosis, which previously seemed unrelated to the pathogenesis of the primary disease, is increasingly raised. In this regard, the aim of this article was to propose a three-level pathogenetic concept capable of linking the primary manifestation of endometriosis (pelvic pain) with other often distant algological patterns, as well as to create an algorithm for managing these patients based on their pathogenetic staging.

From the variety of modern methods of hormonal contraception available in the arsenal of the obstetrician-gynecologist, preference is given to those that include gestagen, which not only reduces the clinical manifestations of androgenous dermopathy, but also increases sexual function, at least not affecting it negatively. Such combined oral contraceptives include Belara, containing chlormadinone acetate 2mg, and ethinyl oestradiol 0.03mg. The choice of this drug is justified by previous studies, which evaluated its safety and ability to stop androgenous dermopathy. At the same time, the impact on sexual function was not taken into account in these studies. The purpose of the study was to determine the effect of combined oral contraceptive containing chlormadinone acetate 2mg, and ethinyl oestradiol 0.03mg on sexual function.
Material and methods. There were examined 68 patients who were prescribed a combined oral contraceptive containing chlormadinone acetate 2mg, and ethinyl oestradiol 0.03mg (Belara) – one tablet for 21 days daily, followed by a seven-day break. The female sexual function index (FSFI) was investigated in dynamics. Statistical data processing was carried out by STATISTICA 13.3 (Tibco, USA).
Results. There were registered the positive effects on sexual health, which consisted in improving all indicators of female sexual function index.
Conclusion. The combined oral contraceptive containing chlormadinone acetate 2mg, and ethinyl oestradiol 0.03mg may be recommended to patients with reduced sexual function as a drug of choice, as well as when reducing sexual function on the taking other contraceptives.

Relevance. The manifestation of polycystic ovarian syndrome (PCOS) in adolescence differs significantly from that in adult women and is often hidden under the mask of physiological changes of puberty, which leads to late diagnosis of this disease. However, there is currently there is no convincing and reliable evidence on the advisability of using a number of medications for the treatment of this syndrome in adolescent girls. From this perspective, the first-line therapy inpuberty, with emerging PCOS, is lifestyle modification.
Aim: to evaluate the effectiveness of therapeutic lifestyle modification (LSM) and micronutrient support in adolescent girls with PCOS.
Materials and Methods. Forty female patients aged 16 to 18 years with a diagnosis of emerging PCOS were included in a prospective study. The patients were divided into 2 groups of 20 subjects each. The 1st group (the main one) – the patients who were recommended to modify their lifestyle in combination with micronutrients (inositol, folic acid, vitamin D, polyunsaturated fatty acids of the omega‑3 family); the 2nd group (the control group) – the girls who were recommended to modify their lifestyle to correct the symptoms of PCOS. The patients’ state was evaluated at the start of treatment, after 3 and 6 months.
Results. The best results were seen in Group 1 (LSM +micronutrients) – a statistically significant effect of combined therapy on the metabolic status was found: a decrease in fasting glucose and insulin levels, lower cholesterol levels, normalization of the body mass index; on the hormonal background: a decrease in androstenedione levels, total testosterone, normalization of the LH/FSH ratio, a decrease in the clinical manifestations of hyperandrogenism; on menstrual cycle recovery with spontaneous ovulation.
Conclusion. The use of micronutrient support, along with LSM, is an effective means of correcting the clinical manifestations of developing PCOS in adolescent girls, as well as the prevention of the negative effects of the disease.

Aim. To determine prognostic criteria for pregnancy complications and perinatal pathology in women with polycystic ovary syndrome.
Materials and methods. A prospective study of 100 pregnant women with polycystic ovary syndrome at the St. Joasaph Belgorod Regional Clinical Hospital. Depending on the type of ART method, 2 groups were formed. The first group (n=50) of women – pregnancy occurred by induction of ovulation with chlorthyanisene clomiphene citrate (CC). The second group (n=50) – with the help of In vitro fertilisation (IVF). Research methods – clinical, laboratory, instrumental.
Result. It was revealed that the main conditions for the probability of the formation of polycystic ovary syndrome and infertility are: the presence of childhood infections in the anamnesis, low birth weight of mothers. Disorders of the reproductive system in polycystic ovary syndrome (PCOS) are detected by menstrual cycle disorders, late menarche, inflammatory diseases of the genitals, primary and secondary infertility. Extragenital pathology is diagnosed in 100 % of women with PCOS and appears in the form of obesity, infectious and inflammatory diseases, infectious and inflammatory pathologies. With PCOS, miscarriage, preeclampsia, isthmic-cervical insufficiency, gestational diabetes mellitus, fetal growth retardation, chronic placental insufficiency are noted. The onset of pregnancy by stimulating ovulation of CC has an unfavorable course relative to IVF: the risk of miscarriage and isthmic-cervical insufficiency is higher. The average weight of full-term babies, the method of their birth turned out to be IVF, is greater than ovulation stimulation. The probability of perinatal damage against the background of ovulation stimulation exceeds IVF by about 1.5 times. In the early period of gestation and in conditions of PCOS, there is a hormonal imbalance: a fascination with TBG and a decrease in the secretion of PAMG in peripheral blood at 7–8 and 10–12 weeks. In women with polycystic ovary syndrome, the probability of termination of pregnancy in the first trimester is characterized by the presence of chorionitis, a decrease in the volume of the amniotic cavity, tachycardia of the embryo. Signs of placental insufficiency were detected in the II and III trimesters. In pregnant women with PCOS, hemostatic disorders are observed – a shortening of the activated recalcification time and blood clotting time and an increase in fibrinogen and prothrombin index. Pregnancy on the background of PCOS is accompanied by activation of free radical oxidation and the development of oxidative stress.
Conclusion. To predict placental insufficiency, the risk of miscarriage, perinatal pathology of the nervous system in pregnant women with PCOS, it is necessary to assess the level of glycodelin, TBG, PAMG‑1, β-HCG.

Relevance. Placental insufficiency is a polycausal syndrome characterized by a violation of the molecular, cellular, tissue and organ adaptivehomeostatic reactions of the fetoplacental system. The active participation of the neutrophil component of the innate immune system in the development of endothelial dysfunction and thrombotic disorders, which underlie many complications of pregnancy, has been proven, which served as the reason for conducting exploratory studies to assess the level of neutrophil extracellular traps (NETs) in pregnant women at different stages of gestation.
The purpose of the study is to identify the features of the formation of neutrophil extracellular traps in pregnant women with normal pregnancy and placental insufficiency associated with thrombophilia
Material and methods. 85 pregnant women in the second and third trimester were examined: 40 women with normal pregnancy (comparison group) and 45 (main group) with thrombophilia (protein S/protein C deficiency) and subcompensated placental insufficiency. The level of NVL was assessed in blood smears according to the monolayer type using an automatic microscopic system MECOS-C 2.
Results. It was found that the level of DNA traps in normal pregnancy and in pregnant women with placental insufficiency at 21–24 weeks of gestation was 1.3 and almost 2 times higher than the level outside pregnancy (p <0.05), with a predominance of phase IIa etosis. By 36–37 weeks, in a normal pregnancy, there was a slight increase in%NVL (16 %), while in the group of pregnant women with placental insufficiency,%NVL increased by 35.7 % compared to the initial data, maintaining a high content of extracellular structures in IIa phase of ethotic transformation (7.4 % versus 5.8 % at 21–24 weeks, p >0.05).
Conclusion. It is obvious that the presence of a high level of NIV indicates a failure of immune defense mechanisms and the development of an inadequate inflammatory response in the pathogenesis of fetoplacental insufficiency, which can be useful when carrying out intermediate dynamic monitoring of the condition of a pregnant woman.

Relevance. A hypercoagulable state caused by hereditary or acquired deficiency of antithrombotic factors can contribute to disruption of the uteroplacental circulation with the development of serious pregnancy complications, which requires effective monitoring of hemostasis during the use of pathogenetic anticoagulant therapy.
The purpose of the study is to improve methods for diagnosing and monitoring hemostatic disorders in pregnant women with thrombophilia (protein C/protein S deficiency) and complicated pregnancy based on the use of an integral thrombodynamic test and quantitative phase imaging of platelets.
Material and methods. 45 pregnant women were examined in the first and second trimester: 20 women with normal pregnancy (comparison group) and 25 (main group) with thrombophilia (protein S/protein C deficiency). 16 pregnant women (subgroup 1A) received a full course of preconception preparation with the prescription of LMWH, 9 pregnant women (subgroup 1B) did not complete the course in full for various reasons. To study hemostasis, along with routine methods (determination of APTT, TT, PT, Fibrinogen, INR and D-dimer), an integral assessment of coagulation using the Thrombodynamics method and quantitative phase imaging (QPI) of platelets in real time were performed.
Results. It was found that routine methods are not sufficiently informative; statistically significant changes against the background of thrombophilia and during treatment with LMWH were noted only based on the results of assessing the level of fibrinogen and D-dimer. In the complex of thrombodynamics indicators, the most sensitive parameters were the steady-state clot growth rate (Vst), clot size at 30 minutes of the study (CS) and clot density (D). The QPI method revealed features of the morphological structure of platelets with a predominance in pregnant women with protein S/protein C deficiency of the activated cell population with an increase in the median values of diameter and perimeter by 14 and 20 %, respectively (p < 0.05). The effectiveness of LMWH therapy was assessed by normalization of the analyzed parameters.
Conclusion. Timely and adequate correction of hemostasis disorders, carried out while monitoring coagulation and platelet parameters, taking into account all clinical data, can significantly reduce the risk of complications for the mother and fetus.