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Reproductive Endocrinology     Open Access   (Followers: 3)
Journal Cover Reproductive Endocrinology
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  This is an Open Access Journal Open Access journal
   ISSN (Print) 2309-4117 - ISSN (Online) 2411-1295
   Published by Trilist Publishing Homepage  [1 journal]
  • Functional hypothalamic amenorrhea: аn endocrine society clinical
           practice guideline, 2017

    • Authors: Catherine M. Gordon, Kathryn E. Ackerman, Sarah L. Berga
      Pages: 13 - 21
      Abstract: Objective: To formulate clinical practice guidelines for the diagnosis and treatment of functional hypothalamic amenorrhea (FHA).Participants: The participants include an Endocrine Society–appointed task force of eight experts, a methodologist, and a medical writer.Evidence: This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation approach to describe the strength of recommendations and the quality of evidence. The task force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies.Consensus Process: One group meeting, several conference calls, and e-mail communications enabled consensus. Endocrine Society committees and members and cosponsoring organizations reviewed and commented on preliminary drafts of this guideline.Conclusions: FHA is a form of chronic anovulation, not due to identifiable organic causes, but often associated with stress, weight loss, excessive exercise, or a combination thereof. The term “functional” implies that correction or amelioration of causal behavioral factors will restore ovulatory ovarian function. Investigations should include assessment of systemic and endocrinologic etiologies, as FHA is a diagnosis of exclusion. A multidisciplinary treatment approach is necessary, including medical, dietary, and mental health support. Medical complications include, among others, bone loss and infertility, and appropriate therapies are under debate and investigation. As part of an initial endocrine evaluation for patients with FHA, we recommend obtaining the following laboratory tests: serum thyroid-stimulating hormone, free thyroxine, prolactin, luteinizing hormone, follicle-stimulating hormone, estradiol, and antiMullerian hormone.
      PubDate: 2017-12-28
  • Modern approaches to correction of vaginal microbiocenosis at the stage of
           preconceptional preparation

    • Authors: О. В. Кравченко
      Pages: 26 - 29
      Abstract: Today in Ukraine and in the world there is a tendency to increase the age of both primiparous women and women, which delay the birth of the second child. This creates certain risks with regard to the increase in the population of women of reproductive age the frequency of extragenital pathology and diseases of the female genital area, in particular, infectious genesis. In this regard, correction of the vaginal microbiocenosis at the stage of pre-conceptual preparation acquires special significance.The aim of the study to evaluate the effectiveness of the drug Depantol for the treatment of nonspecific vulvovaginitis at the stage of pre-conceptual preparation.Under supervision there were 45 women aged 24–32 years. The diagnosis of non-specific vulvovaginitis verified according to the clinical and laboratory methods of the study. All patients was prescribed the drug Depantol by 1 suppository 2 times a day for 10 days. Treatment efficacy was evalued according to the clinical and microbiological examination before treatment, and at 1 and 3 months after treatment.As a result of the study, the clinical and laboratory efficacy of the proposed therapy was substantiated. The absence of subjective symptoms after treatment was ascertained, bacteriological study confirmed the effectiveness of therapy in 95.6% of cases.The author of the study notes that the drug Depantol is highly effective in relation to the main pathogens of non-specific vulvovaginitis, which makes it the drug of choice in preconception preparation. Depantol does not interfere with the functional activity of lactic acid bacteria, which contributes to the rapid restoration of the normal biotope of the vagina and creates favorable conditions for conception.
      PubDate: 2017-12-28
  • Trichomonas Vaginalis: controversy questions

    • Authors: О. А. Бурка, І. В. Сідорова
      Pages: 31 - 34
      Abstract: Trichomoniasis is the most common non-viral infection in the sexually transmitted world and is caused by Trichomonas vaginalis, a single-celled parasite that belongs to the flagellate class. Trichomoniasis is not subject to reporting in many countries, and therefore, assessing the prevalence of infection in population screening is complicated.According to the WHO, in 2008 there were 276.4 million cases, the global prevalence of Tr. vaginalis was 8.1% for women and 1.0% for men. The level of Tr. vaginalis differs greatly from the population, the country, the methods of identification of the pathogen. One of the important reasons for diagnosis and treatment of T. vaginalis is the increased risk of infection and transmission of HIV from 2.1 to 2.8 times when it is available.Most women (85%) and men (77%) with Tr. vaginalis have no clinical symptoms. In one third of infected women, symptoms appear within 6 months. Among those who have clinical manifestations, they are nonspecific: the presence of vaginal discharge of varying intensity and density, dysuria, itching, irritation, aching pain in the lower abdomen. The available diagnosis for Tr. vaginalis ranges from basic microscopy to nucleic acid amplification assays. Women are recommended to take biological material from the posterior vaginal fornix, men – urine, ejaculate, secret prostate.ML DILA proposes the definition of Tr. vaginalis by the gold standard method of InPouch, or the simultaneous determination of the most common 4 pathogens and 3 conditional pathogens by the method of “Screening of STIs”. Control of treatment effectiveness according to the CDC Sexually Transmitted Diseases Treatment Guidelines are recommended for all women within the first 3 months after treatment, regardless of whether they consider their sexual partners cured, which is associated with a high risk of reinfection.
      PubDate: 2017-12-28
  • Symptomatic uterine fibroids – targeted pharmacotherapy Consensus of
           an expert meeting

    • Authors: T. Römer, K. Doubek, D. Foth
      Pages: 35 - 41
      Abstract: On 14 December 2016, independent and hospital-based gynaecologists gathered in Frankfurt am Main for an expert meeting with a view to developing a consensus paper on the treatment of uterine fibroids (leiomyomas) in gynaecological practice. Attention was paid in particular to the new aspects of targeted pharmacotherapy.The experts reached consensus on the requisite diagnostic examinations, and devised an algorithm for managing symptomatic uterine fibroids in premenopausal and perimenopausal women. The central decision in the treatment algorithm is the question whether there is a desire to preserve the uterus. Prior to performing hysterectomy in an anaemic patient not wanting to preserve the uterus, preoperative treatment with UPA is worthwhile. If there is an indication for surgery combined with the desire to preserve the uterus, it is necessary to consider from the surgeon’s perspective, how useful it would be to undertake preoperative treatment with UPA. In particular, this applies to hysteroscopic resection. Preoperative treatment may also be worthwhile prior to laparoscopy and laparotomy procedures if there are large or multiple fibroids as per FIGO 2.In case of secondary anaemia or fibroids in an unfavourable location, especially in patients who wish to have children, e.g. close to the tubes or cervix, preoperative pharmacological treatment with UPA may also be indicated. The surgery can thus be optimised and in patients wishing to have children it will prove less detrimental.In general, in the management of fibroids, it is preferable to take a causal approach early on by employing targeted pharmacological treatments. Combined oral contraceptives, progestins and LNG-IUS therefore are not advantageous in such a situation. Flexible interval therapy with UPA, ideally beginning with two 12-week courses of treatment separated by a treatment-free interval of approximately two months, offers an alternative to surgical and interventional radiological procedures.As experts says, the use of targeted, long-term pharmacological treatments can help reduce the need for surgery on uterine fibroids and also lower the number of hysterectomies, in particular, and in the long term improve patient quality of life.
      PubDate: 2017-12-28
  • Varicose veins of the small pelvis and pelvic congestion syndrome. A
           differentiated approach: the choice of method of contraception, treatment,

    • Authors: А. Н. Григоренко, А. Б. Гордийчук
      Pages: 42 - 52
      Abstract: The article considers the main points that affect the quality of life of women with varicose veins of small pelvis with congestion and without it, in particular the use of hormonal methods of contraception, and also discussed the issues of diagnostics, prevention and treatment of these diseases. Algorithms of clinical tactics for conducting such patients are presented. Particular attention is focused on the features of the appointment of hormonal drugs in this category of women. You can determine the methods of treatment and avoid long-term unreasonable prescription of various medicine (especially hormones that will mask or worsen the course of the disease) if you select groups of women with varicose veins of the small pelvis without congestion and with it (reflux).Varicose veins of the small pelvis and pelvic congestion syndrome are conditions that require an interdisciplinary and differentiated approach. Symptoms of these conditions can be put on a mask of various gynecological, urological, traumatological diseases. Anatomical and physiological features of the structure of the veins and the regulation of their venous tone explain the possibility of forming a venous congestive syndrome in women. This can be due to two reasons: due to the violation of the outflow of venous blood or due to the obstruction of any vein of the ovary, any increase in intravascular pressure not controlled by the venous tone at the level of the pelvis.Varicose veins of the small pelvis and pelvic congestion syndrome remain unexplored until the end. There are no uniform standards for their diagnostics. Varicose veins of the small pelvis and pelvic congestion syndrome are different diseases which requiring an understanding of the mechanisms of their development and consequences. If a pelvic varicose veins are suspected, the first diagnostic test is usually ultrasound. Modern ultrasound technique can evaluate blood flow in various veins. To study the blood flow in the veins, laparoscopy, venography in combination with CT or MRI can also be performed.
      PubDate: 2017-12-28
  • Translabial ultrasound: “three tracks” technique

    • Authors: В. В. Дощечкин
      Pages: 53 - 57
      Abstract: Introduction: there are various options for the application of an ultrasound transducer in transperineal sonography procedure (TPUS), starting from percutaneous scanning of the perineum area by sector transducers and ending with the use of transalabial (TLUS), transvaginal (TVUS) and transrectal access by the intracavitary transducers. In all these cases, it is necessary to identify the relationships of pelvic organs. The ultrasonic technique of the “three tracks” (TTT) allows real-time evaluation of the spatial ratio of the urethra, vagina and rectum, as well as adjacent subjects of the pelvis, visualizing them simultaneously in the same scanning plane.Objective: to present the “three track» technique used in the conduct of translabial ultrasonography, and to study the results of revealing the pathology in lower pelvis in comparison with routine transvaginal ultrasonography (TVUS).Participants, settings, methods: the study was conducted between January 18, 2016 and November 27, 2017 in the clinic for reproductive medicine “Remedi” (Odesa). Informed consent to the investigation was obtained from all females. 70 patients of the main group underwent translabial ultrasonography in the “three track” technique (TLUS + TTT). 71 women of comparative group underwent a routine transvaginal ultrasonography.Results and discussion: visualization of three tracks: urethra, vagina and rectum in one scan plane was achieved in 65 patients of the main group (93%). In addition, in the main group, approximately twice as often as in the comparison group, a rare pathology of the lower pelvis, such as Gartner duct cysts, the Bartolin cysts, the deep endometriosis of the rectovaginal septum and unclassified cysts of the vagina, were found. However, the insufficient number of obtained results does not allow confirming their reliability.Conclusion: the using of TTT during TLUS, extends the diagnostic opportunities of the examiner in the evaluation of the relationship of adjacent organs and tissues in the pelvic floor and lower pelvis. The method requires further research and can be used as an additional bonus to improve for accuracy and safety of diagnostic and surgical gynecological practice.There is no conflict of interest to declare.
      PubDate: 2017-12-28
  • Screening for endocrine hypertension. An Endocrine Society scientific

    • Authors: William F. Young Jr., David A. Calhoun, Jacques W.M. Lenders
      Pages: 58 - 71
      Abstract: Hypertension may be the initial clinical presentation for at least 15 endocrine disorders. An accurate diagnosis of endocrine hypertension provides clinicians with the opportunity to render a surgical cure or to achieve an optimal clinical response with specific pharmacologic therapy. It is challenging for the clinician to know when and how to perform case-detection testing for all the endocrine disorders in which hypertension may be the presenting symptom. Herein, we review the different forms of endocrine hypertension, with a focus on prevalence, clinical presentation, guidance on when to perform case detection testing, and currently available case-detection tests.Hypertension affects 28.6% of adults in United States. In most, hypertension is primary (essential or idiopathic), but a subgroup of approximately 15% has secondary hypertension. More than 50% of children who present with hypertension have a secondary cause. In young adults (< 40 years old), the prevalence of secondary hypertension is approximately 30%. The secondary causes of hypertension include renal causes (e.g., renal parenchymal disease) and endocrine causes. Hypertension may be the initial clinical presentation many endocrine disorders: pheochromocytoma and sympathetic paraganglioma, primary aldosteronism, hyperdeoxycorticosteronism (congenital adrenal hyperplasia – 11b-hydroxylase deficiency, 17a-hydroxylase deficiency, deoxycorticosterone-producing tumor, primary cortisol resistance), cushing syndrome, apparent mineralocorticoid excess / 11b-hydroxysteroid dehydrogenase deficiency, hyperparathyroidism, secondary hyperaldosteronism, renovascular hypertension, hypothyroidism, hyperthyroidism, obstructive sleep apnea and others.Clinical context is important. For example, case detection for endocrine hypertension may not be clinically important in an older patient with multiple life-limiting comorbidities. However, screening for endocrine hypertension may be key to enhancing and prolonging life in most patients with hypertension, especially younger patients.
      PubDate: 2017-12-28
  • The effectiveness and safety of mht depending on the type, route of
           administration of estrogens, and the type of progestogen. Analysis of data
           from clinical trials and international recommendations

    • Authors: С. О. Шурпяк
      Pages: 72 - 80
      Abstract: The hormone therapy remains the most effective method for treating of the vasomotor symptoms and genitourinary syndrome in menopause. The evidence available to date suggests that for women younger than 60 and with a postmenopause no more than 10 years without contraindications, the benefits of administering systemic hormone therapy for the treatment of vasomotor symptoms, sleep disorders and prevention of bone loss exceed possible risks. In addition, the data about statistically significant reduction in all-cause mortality in women who initiate hormone therapy before the age of 60 and/or 10 years after the onset of menopause have been obtained.Menopausal hormone therapy (MHT) includes a wide range of hormonal drugs and administration routes that potentially have different risks and benefits, and therefore the term “class effect” is misleading and inappropriate. The risks of menopausal hormone therapy vary depending on the composition, dose and route of administration of hormones, as well as the timing of the onset and duration of use of both estrogens and progesterone. The use of transdermal estrogens in combination with progesterone seems safer for venous thromboembolism, especially in high-risk women. The use of transdermal estrogen drugs in comparison with oral estrogens is associated with a lesser likelihood of developing thrombotic risk, and possibly the risk of developing stroke and coronary heart disease. If progesterone is needed, micronized progesterone is a safer alternative.MHT requires a periodic reassessment of the benefits and risks for deciding whether to continue or stop using it. The use of postmenopausal hormone therapy in women with menopausal disorders should be based on an assessment of all risk factors for cardiovascular disease, age and time from the onset of menopause. The duration of therapy should be motivated by the indications, and the decision should be taken in conjunction with the doctor.
      PubDate: 2017-12-28
  • Treatment for mastalgia in the presence of diffuse mastopathy in female
           patients during the menopausal transition period

    • Authors: Н. В. Кулагина
      Pages: 81 - 85
      Abstract: Objective. To evaluate the efficacy and tolerability of Mastodynon® in the treatment of diffuse mastopathy and symptoms of premenstrual syndrome (PMS) in women in the menopausaltransition period.Subjects and methods. A clinical prospective, parallel-group, randomized, monocenter, open-label trial with active control was conducted. The trial included 60 patients (mean age, 49.0 ± 3.1 years) who used Mastodynon® or bromocriptine for 24 weeks.Results. Hyperprolactinemia was detected in 63.3% of the women suffering from different forms of diffuse mastopathy in the menopausal transition period. There was a statistically significant decrease in prolactin levels at 24 weeks of treatment with Mastodynon® (Δ -244 ± 95.8 mU/ml) (p < 0.001) and bromocryptine (Δ -226.4 ± 101.5 mU/ml) (p < 0.001). The results of therapy with Mastodynon® were comparable to the efficiency of that with bromocryptine (p > 0.05). Ultrasound mammography revealed positive changes in the breast structure in 67% of the patients with different forms of diffuse mastopathy treated with Mastodynon® and in 43% of those treated with bromocriptine. There was a decrease in the incidence (92% vs 37%; p < 0.001) and severity of mastalgia at month 6 of Mastodynon® treatment, the results of therapy did not differ in the two groups (p > 0.05). Treatment with Mastodynon® in patients with different forms of mastopathy concurrent with the symptoms of PMS was more effective than that with bromocryptine in relieving autonomic disorders (p < 0.05). Adverse events (AEs) occurred more commonly in the patients receiving bromocriptine (60%); AEs were noted in 7% in the Mastodynon® group (p < 0.05).Conclusion. Mastodynon® that contains Vitex agnus-castus extract is an effective agent with a high safety profile to treat mastalgia and symptoms of PMS in patients with different forms of diffuse mastopathy during the menopausal transition period.
      PubDate: 2017-12-28
  • Prediction of heavy degree of flow of menopausal disorders for women with
           hyperproliferative processes of reproductive system using a mathematical

    • Authors: Л. І. Бутіна
      Pages: 86 - 90
      Abstract: Objective. Prognostication of heavy degree of flow of menopausal disorders in women with hyperproliferative processes of reproductive system.Materials and methods. For the exposure of factors, related to severity of flow of climacteric syndrome (CS) and estimation of degree of their influence on development of heavy degree of flow of menopausal disorders, the method of construction and analysis of multivariable mathematical models was utilized. The results of investigation of 19 indexes from 124 women aged 45 to 79 with menopausal disorders (climacteric syndrome) and with signes of hyperproliferative processes of reproductive system according to the data of ultrasound survey of uterus and the results of histology investigations of uterine mucosal scrapings were used for construction of model.Results of the study. On the basic of analysis of coefficients of logical model of regress the result was determined. Presence in women operation on the appendages of uterus promotes the risk of development of heavy degree of flow of disorders in menopause (p = 0.006) with odds ratio (OR) = 7.6 and the 95% confidence interval (CI) 1.8–32.8. Presence of chronic inflammatory diseases of privy parts (p = 0.004, OR = 27.6, 95% CІ 2.8–269.7), presence of hypermenstrual syndrome (p = 0.009, OR = 7.0, 95% CI 1.6–29.7), presence of diseases of liver and bilious ducts (p = 0.001, OR = 9.9, 95% CI 2.5–40.1), presence of stomach and intestine diseases (p = 0.010, OR = 5.9, 95% CI 1.5– 23.0) promotes the risk of development of heavy degree of flow of menopausal disorders.Conclusions. Presence for women with hyperproliferative processes of the reproductive system an operation on the appendages of uterus, chronic inflammatory diseases of genitals, hypermenstrual syndrome, diseases of liver and bilious ducts, stomach and intestine promotes the risk of development of heavy degree of flow of menopausal disorders.
      PubDate: 2017-12-28
  • Rational preparation of generic ways as a method of reducing traumatism of
           soft tissues on childbirth

    • Authors: Н. А. Щербина, В. В. Бобрицкая, О. П. Липко
      Pages: 91 - 95
      Abstract: The urgency of the problem of traumatization of the birth canals is due in many respects to the morphological and functional inferiority of the constituent layers of the vagina. A clinical study was conducted on the effectiveness of the using of vaginal suppositories of the natural complex action Revitaxa with the aim of preventing the traumatization of soft tissues in parturition.In the clinical study, 50 pregnant women aged 23–34 years were under observation in the pregnancy from 37 to 40 weeks. 25 pregnant women, who were included in the main group, received suppositories vaginally at 1 per day (overnight) for 10 days, 40% of pregnant women were prolonged using the Revitaxa remedy up to 20 days before the onset of labor. 25 pregnant women, who made up a control group, did not receive vaginal suppositories, as well as other special prenatal preparations. The control of the effectiveness of the vaginal suppositories of Revitaxa was carried out using Sonography in the mode of Color Doppler Сards, vascularization of the vaginal wall, echographic mucosal picture, elastography of the vaginal wall was assessed.After delivery, the presence of gaps in the soft tissues of the birth canal was evaluated in patients in the main and control groups. As a result of the using of suppositories, the indicators of the birth traumatism of soft tissues in the main group were significantly lower than in the control group, positive sonographic and elastographic changes were noted. In addition, there was an improvement in the colposcopic pattern in pregnant women with ectopic cervix uteri – a decrease in the area of ectopia, a lack of progression of dysplastic changes.Complex composition of vaginal suppositories Revitaxa – hyaluronic acid and 4 natural components (marigold extract, aloe extract, Centella extract of Asiatic, tea tree oil extract) – allows to expand the possibilities of using to prevent the risks of traumatization of the birth canal. Components of suppositories affect the tone of elastic and collagen fibers stimulating glycogenesis, provide the necessary protective environment, vascularization of tissues, strengthen the matrix of connective tissue, and also show antiseptic and local immunomodulatory effects.
      PubDate: 2017-12-28
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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Fax: +00 44 (0)131 4513327
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