Menopausal hormone therapy (MHT) remains the most effective treatment for vasomotor symptoms and genitourinary syndrome of menopause. MHT, initiated in women during the “therapeutic window” to relieve symptoms of estrogens deficiency and prevent or treat osteoporosis, is the only intervention that reduces the risk of cardiovascular diseases and diabetes in healthy middle-aged women. MHT must be individualized and adapted; that is, a differentiated selection of therapy should be carried out, considering the woman’s health status and her comorbidities, as well as the MHT regimen (type, dose, route of administration and possible side effects). The article reflects the algorithms for prescribing MHT in different periods of menopause, which allow applying an individualized approach to patients who need MHT.
Endometrial hyperplasia (EH) is a pathological condition characterized by proliferation of the endometrial glands with an increase in the glands/stroma ratio compared to normal proliferative endometrium. EH is a precursor to the development of one of the most common gynecological malignancies – endometrial cancer. There are EH without atypia and with atypia.Total hysterectomy with bilateral salpingo-oophorectomy is the method of choice in the treatment of atypical EH. It is important to eliminate risk factors – overweight patients should lose weight by adjusting diet, increase physical activity. Recently, aromatase inhibitors have also proven to be an effective treatment option for EH with atypia. Oral progestogens and the levonorgestrel-releasing intrauterine device are methods of choice for conservative treatment of premenopausal and postmenopausal women with atypical EH.However, not all patients can use progestins for a long time due to possible side effects. Failure of progestin treatment may depend on various factors, such as the patient’s age, health status, other conditions, and the degree or type of hyperplasia. So it is important to look for new methods of EH management and adjuvant drugs that will potentiate the effectiveness of basic treatment, as well as opportunities to reduce the risks of progesterone receptor resistance and potentiation of progestins. Cridanimod is a new small molecule that has been shown in studies to increase the progesterone receptors expression in the endometrium. It has been suggested that in combination with progestin therapy it increases the progesterone receptors expression and thus improves the effectiveness of treatment. Research results allows to consider the possibility of using cridanimod in complex EH therapy, especially against the background of viral infection. Cridanimod reduces the risk of resistance to progestogen therapy in EH, provides the best result after conservative treatment and reduces the number of relapses.
Non-alcoholic fatty liver disease (NAFLD) is currently the most common form of chronic liver disease, affecting 10–20% of the total pediatric population, including 8% of non-obese children and 50–80% of those who are obese.Purpose of the study was to determine the characteristics of vitamin D status in Ukrainian adolescent girls with NAFLD and metabolically unhealthy obesity.Materials and methods. 120 girls aged 12–17 years with NAFLD and metabolically unhealthy obesity, as well as 180 conditionally somatically healthy girls with normal sexual development and normal body weights (control group) were under observation. The examination set included clinical and anamnestic data, anthropometry, assessment of sexual development, clinical blood test, general urinalysis, coprogram, parasitological examination of feces, electrocardiography, lipid profile, glucose, insulin, HOMA index, alanine aminotransferase, aspartate aminotransferase, total protein, amylase, blood test for markers of hepatitis B, C, autoimmunological studies, ultrasound and elastography of the hepatobiliary system, consultation with an endocrinologist, gastroenterologist, according to the indications - cardiologist, pulmonologist, allergist and other specialists.Results. A characteristic feature of vitamin D status in adolescent girls with NAFLD and metabolically unhealthy obesity was its deficiency in 65.83% of cases, while in the control deficiency was observed less often 1.5 times – in 43.89 % of patients. The average 25(OH)D level in the group without steatosis was 22.00 ± 0.56 ng/ml, while in patients with NAFLD and metabolically unhealthy obesity it was 1.34 times lower – 16.44 ± 0.73 ng/ml. Conclusion. Correlation analysis showed the role of 25(OH)D deficiency in the development of diffuse liver diseases, disorders of lipid, carbohydrate, and purine metabolism in adolescent girls with NAFLD and obesity, that is requires an adequate correction of the status of this vitamin during treatment.
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