The article presents new data on the significance of vitamin D deficiency in the formation of endometrial structure disorders in women with luteal phase defect and unrupted follicle syndrome. Disorders of the menstrual cycle caused by a progesterone deficiency from the position of influence on the onset and progression of pregnancy are considered. Fertility of women, especially with endocrine imbalances, deserves special attention, since the frequency of early pregnancy loss in them is about 67 %. Aim: study of the effects of vitamin D deficiency and progesterone deficiency in the luteinized unruptured follicle syndrome (Geis-Genes) and the luteal phase defect on the reproductive potential of women. Materials and methods: a hormonal study, determination of vitamin D levels, a sonographic study conducted on days 5–7 and 21–24 of the menstrual cycle in the periconceptional supplementation program of 45 women with luteal phase deficiency (LPD) and luteinized unruptured follicle syndrome (LUF). Results: The relationship between the content of vitamin D and the hormonal levels of the reproductive system of women with LPD and LUF is traced. The role of reducing vitamin D levels in the formation of hormonal imbalances in women of reproductive age has been established. Conclusions: – progesterone deficiency entails changes in various regulatory substances of the reproductive system, and therefore the periconceptional supplementation must be individual. – The introduction of the definition of vitamin D in the periconceptional supplementation plan and its correction are justified and necessary to improve the structure of the endometrium and its secretory transformation in women with progesterone imbalance.
This article refers to the issues of alopecia and acne pathogenesis: anatomy of hair and sebaceous glands, biological factors affecting the stages of hair development and function of sebaceous glands. Alopecia is divided into two large groups: scaring and non-scaring alopecia, the later is represented by alopecia areata, telogen effluvium, and female pattern hair loss/androgenetic alopecia (FPHL/AGA). Before starting the search for systemic causes it is necessary to predetermine the type of alopecia on the basis of medical history and external manifestations. FPHL /AGA as a most common form of alopecia can often coexist with another common pathology – telogen effluvium, this fact determines therapeutic approaches and their results.Main pathogenetic mechanisms, approaches to differential diagnostics and treatment of the main specified types of non-scarring alopecia are reviewed. FPHL/AGA is a main type of alopecia which is often referred to gynecologists/endocrinologists. It is now regarded a multifactorial pathology with the involvement of a genetic component, androgen receptor gene expression, dihydrotestosterone synthesis and local low grade inflammation specifics. FPHL/AGA can be with and without hyperandrogenism, in both cases it can be accompanied by an increased risk of metabolic syndrome. In case of FPHL/AGA with hyperandrogenism the success of treatment depends on the consistent coordinated work of gynecologist/endocrinologist and dermatologist/trichologist, which allows combining systemic and local therapy in a timely manner.Also contemporary views on the acne pathogenesis are reviewed. Given the complex nature of acne its therapy is also complex and stepwise. According to current clinical guidelines and recent studies of the microbial component of acne pathogenesis the following conclusions are formulated. Patients with acne require assessment of androgen status, determination of the hyperandrogenism source, including evaluation of tissue androgens; phenotype of the syndrome and cardio-metabolic risks should be determined in patients with polycystic ovary syndrome; it is advisable to determine antimicrobial susceptibility of pathogens isolated from the inflamed pilosebaceous unit if acne form requires the local or systemic antibacterial therapy.
Abnormal vaginal discharge (AVD) is a syndrome that combines conditions of different origin (microbial/non-microbial) and of different anatomical localization (limited to vagina and exocervix/spreading from the endocervix to the pelvic organs) that cause discomfort and changes in the characteristics of vaginal discharge.Review objective: to systematize modern approaches to the diagnosis of the most common causes of AVD – bacterial vaginosis (BV), trichomoniasis, aerobic vaginitis (AV), vulvovaginal candidiasis (VVC) – in a practical context. Laboratory component of diagnosing the AVD causes should be complex due to the not fully understood mechanisms of regulation of vaginal biocenosis and changes in the virulence of opportunistic and pathogenic flora, leading to an increase in the frequency of mixed forms of vaginosis and their atypical course. The tasks of laboratory tests in AVD are determination of the sexually transmitted infections (gonorrhea, chlamydia, Mycoplasma genitalium) more often as a concomitant asymptomatic infection in combination with BV or another cause of AVD; confirmation of the suspected cause of AVD (BV, trichomoniasis, AV, VVC); differential diagnosis with more rare microbial causes (cytolytic vaginosis) and non-microbial causes.Vaginal pH and microscopy of vaginal discharge with an assessment according to the diagnostic criteria for dysbiosis are first line of available diagnostic tests of BV, AV and VVC. They make it possible to differentiate typical AVD causes from non-microbial AVD causes and rare causes of microbial AVD. Additionally, complex modern molecular methods for assessing the vaginal biocenosis can be used. Cultural methods play an important role in the diagnosis and treatment of recurrent/complicated VVC and AV. PCR for chlamydia, gonorrhea, trichomoniasis and Mycoplasma genitalium is a mandatory component of a comprehensive test in patients with suspected BV, AV or mixed dysbiosis. Patients diagnosed with BV or trichomoniasis has to be tested for HIV and sexually transmitted infections.
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