Тенденции по увеличению продолжительности жизни, которые наблюдаются в последние десятилетия, напрямую затрагивают деятельность акушера-гинеколога ввиду того, что женщинам необходимо не только прожить долгую жизнь, но и снизить количество заболеваний, развитие которых нередко связано с наступлением периода менопаузального перехода и постменопаузы. Задача врачей – помочь пациенткам максимально мягко войти в период постменопаузы, минимизировав проявления климактерического синдрома. В настоящее время наиболее эффективным методом терапии ранних климактерических симптомов является менопаузальная гормональная терапия. В статье рассмотрены современные подходы к проведению менопаузальной гормональной терапии при возникновении менопаузальных расстройств, подходы к подбору менопаузальной гормональной терапии с учетом особенностей каждой конкретной пациентки. Рассматриваются терапевтические эффекты и возможности менопаузальной гормональной терапии, проблемы ее приемлемости, а также ведение пациенток в постменопаузальном периоде с маточными кровотечениями. The trends in life expectancy that have been observed in recent decades directly affect the activities of an obstetrician-gynecologist due to the fact that women need not only to live a long life, but also to reduce the number of diseases, the development of which is often associated with the onset of the menopausal transition and postmenopause. The task of doctors is to help patients to enter the postmenopausal period as gently as possible, minimizing the manifestations of the climacteric syndrome. Currently, the most effective method of treating early climacteric symptoms is menopausal hormone therapy. The article discusses modern approaches to the conduct of menopausal hormone therapy in the event of menopausal disorders, approaches to the selection of menopausal hormone therapy, taking into account the characteristics of each individual patient. The therapeutic effects and possibilities of menopausal hormone therapy, the problems of its acceptability, as well as the management of postmenopausal patients with uterine bleeding are considered.
Iron deficiency anemia is a frequent companion in postmenopausal women and those who have reached adulthood. Anemia in mild form in elderly women often occurs almost asymptomatically. Over time, iron deficiency progresses: severe complications occur, the quality of life decreases significantly, and the prognosis for life becomes unfavorable. A cross-section of the literature data in recent years shows that iron, folate, vitamin B12 deficiency, gastrointestinal diseases, pathologies in the processes of erythropoiesis and other somatic diseases come to the fore in terms of the etiological factors of anemia in elderly women. An important role in the development of anemia in older women is played by an irrational diet throughout life, which causes a lack of iron and folate in food. That is why therapy with a complex drug, which includes iron (II) fumarate in combination with folic acid is a rational choice in comparison with iron monotherapy for the prevention and treatment of anemia in elderly women. The administration of oral iron preparations for the correction of iron deficiency and for the purpose of selecting an effective pathogenetic therapy for anemia solves the problem of complications and improves the quality of life of older women. Iron (II) fumarate + folic acid - a tablet form of iron preparation in combination with folic acid for oral use, which has good tolerability, quickly replenishes iron reserves in the body of elderly patients, reducing mortality in this age group.
The incidence of HLA-DQA1 alleles was assessed in patients with insulin-dependent diabetes mellitus (IDDM), their relatives, and healthy controls using HLA-DQA1 genotyping by digestion of PCR amplified DNA with allele-specific restriction enzymes. A significant increase in the incidence of HLA-DQA1*0301 allele was observed in diabetics although the ratio of DQA1*0301 homozygotes to heterozygotes was similar in the patients and controls. The presence of one DQA 1*0301 allele in the genome appeared to be sufficient for susceptibility to IDDM. Comparison of the incidence of other DQA1 "Arg52" alleles in diabetics and healthy controls revealed no differences between the groups. The incidence of DQA1 "non-Arg52" alleles (specifically DQA1*0201) was reduced in diabetics as compared to normal controls. The presence of these alleles may be considered as the "protective" factor.
Introduction. Research in recent years has shown that sexual dysfunction is now common in post-menopausal women and that it has a significant impact on their quality of life.Aim: to identify the major causes of sexual dysfunction in postmenopausal women and their treatment options, by analysing different literature sources.Materials and methods. During the study of this problem, 25 sources of literature, both Russian and foreign, dating from 2007 to 2020 were analysed.Results and discussion. The main etiological aspects of sexual dysfunction in postmenopausal women, such as disorders of sexual desire, sexual pain disorders, orgasmic disorders are considered in this article. The role of physiological processes occurring in a woman’s organism during this age period in the formation of sexual dysfunction is presented, namely, the influence of insufficiency of sex hormones (In particular, estrogens) and genitourinary syndrome on disorders of the sexual sphere.The main methods of treatment are described, including hormone replacement therapy, the use of non-invasive laser technology, and surgical correction of the dysfunction and atrophy of the pelvic floor muscles. Particular attention is paid to the use of the synthetic steroid tibolone and flibanserin, a drug used to treat hypoactive sexual desire disorder, and the data concerning their high efficacy are presented.Conclusions. The predominant manifestation of sexual dysfunction are disorders of sexual desire and sexual pain disorders. Thus it is important to pay attention to this problem and to treat sexual dysfunction by treating its causes.Conclusion. The treatment of sexual dysfunction must address the causes. In many cases, psychotherapy is necessary. MHT has a positive effect on the sexual function of patients. Testosterone therapy is justified in this case, but is rarely used, as it has a number of side effects and contraindications. Synthetic steroids (Tibolone) have shown good results in the treatment of sexual dysfunction.
Protection of women’s reproductive health and fertility is one of the priorities for the modern medicine. The prevention of an unintended pregnancy is critical for successful solving of this problem. Prevention of unwanted pregnancy and abortion, medical and social counselling are an integral part of the obstetrician-gynecologist activities. The effectiveness of preventing an unwanted pregnancy is a major factor in choosing a remedy, as well as the ease of use. The article presents information on the new modern contraception methods, including prolonged forms of combined hormonal contraception. A comparative analysis of oral and parenteral contraceptives is provided. The authors gave criteria of efficacy and principles for rational choice of contraceptives. The mechanism of action of a hormonal contraceptive drug containing etonogestrel and ethinyl estradiol is described. The article reviews the main advantages, indications for use and side effects of hormonal releasing systems, which contraceptive effect is provided by a combination of various factors. The suppression of ovulation is the most important of these factors. The researchers provided an analysis of the effect of the vaginal hormonal ring on the biocenosis of vagina and cervical mucosa, on the course of background cervix diseases and the possibility of preventing the development of pathogenic flora, as well as the benefits of its use in women with uncomplicated ectopia of the cervix: the effect on the epithelization of ectopia of columnar epithelium and the beneficial effect on endometrioid heterotopia. The article presents data on the frequency of adverse effects associated with the use of the contraceptive method, as well as risk factors that may become a contraindication to the use of the vaginal hormonal ring. Clear guidelines for postabortion contraception are provided.
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