In this review we summarize current data on prevalence, etiology and pathogenesis resulting in premature ovarian insufficiency (POI). In particular, genetic, autoimmune, metabolic, iatrogenic disorders as well as unfavorable impact of environmental factors represent key pathogenetic mechanisms underlying POI development. Clinical picture of this disease is mainly manifested by oligo- and amenorrhea as well as genitourinary menopausal syndrome (GUMS). Special attention is paid to a link between such clinical signs and psychosocial discomfort not being a life-threatening condition but still able to markedly lower quality of woman’s life and considered as a comorbidity with type 2 diabetes mellitus, osteoporosis and cardiovascular diseases. Hormone replacement therapy (HRT) serves as the first-line therapeutic approach for treating POI, which is performed according to the principles similar to those used to perform menopausal hormone therapy (MHT) in case of natural menopause that should be continued until reaching at least the average age for the onset of menopause. Topical estriol therapy eliminates GUMS symptoms, which in turn positively affects sexual function and woman’s psychosocial status and contributes to improved quality of life. The data from recent studies examining topical estriol therapy in POI demonstrated high efficacy and safety. Finally, we also discuss diverse strategies to support reproductive function in women with POI.

During the past decades, the prevalence of cancer diseases of female reproductive system has been constantly growing. The issue is especially acute in reproductive-age women because of earlier oncological pathology onset. Morpho-functional disorders and aggressive methods of anti-tumor therapy significantly affect the patients’ quality of life, psychological well-being, emotional stability, and family relationship, which leads to a limitation of physiological and social possibilities. Rehabilitation programs for oncological patients target to prevent unwanted sequela of the disease, its therapy, and relapses. Pre-rehabilitation plays a special role. It includes psychological and specialized medical care for the patient during the period from the disease verification to the start of therapy. Timely rehabilitation measures reduce the rate of repeated hospitalizations for side effects of chemotherapy, radiotherapy complications, antitumor therapy, and radical surgical interventions. Rehabilitation as a part of standard therapeutic strategy can reduce pharmacoeconomical burden for the health care system. However, further clinical and pharmacoeconomic studies are required for the implementation of rehabilitation at the level of the health care system.

Background. The increase in the proportion of patients with menopausal syndrome (MS) and surgical menopause, including women in the recovery phase after radical surgical treatment of the reproductive system cancer, is a characteristic trend of the 21st century. Part of them receive menopausal hormone therapy (MHT). This determines the relevance of the analysis of the specified cohort of patients to enhance rehabilitation programs designed to improve the quality of life (QoL) in this category of gynecological patients.Objective: subanalysis of primary data from the MAGYN study cohort of MHT treated women with MS and surgical menopause.Material and methods. The MAGYN observational non-interventional study of the real clinical practice included 9168 women, of whom 1528 represented a group of previously not characterized MHT treated women with MS and surgical menopause. To determine the number of patients with magnesium deficiency (MD), a Magnesium Deficiency Questionnaire (MDQ) was used, a biochemical blood test with an indicator of serum magnesium concentration was evaluated. The profile of the participants was analyzed by the presence of general somatic pathologies, obstetric, gynecological history, complaints, symptoms of MD on a visual-analog scale. The QoL was assessed with the help of The World Health Organization Quality of Life Brief Version (WHOQOL-BREF) before the start of a 4-week course of MD supplementation and after treatment.Results. According to the MDQ results, the prevalence of DM was 79.4%, which exceeded the results of all other groups in the study. Women with MD had a higher incidence of viral infections (19.2% vs. 22.7%; p=0.028), vegetative-vascular dystonia (26.2% vs. 29.7%; p=0.0466) and osteochondrosis (42.9% vs. 46.8%; p=0.0453). A subgroup of participants with verified MD demonstrated significantly more pronounced symptoms, such as irritability (4.9±3.5 vs. 4.6±3.4 points in the general group; p=0.0437), sleep disorders (4.4±2.3 vs. 4.2±2.3 points; p=0.0491), back pain (3.9±2.0 vs. 3.7±2.0; p=0.0405), and increased fatigue (4.6±2.3 vs. 4.4±2.3 points; p=0.0444). After the end of the course of therapy with fixed dose combination of magnesium citrate and pyridoxine, the sum of MDQ scores decreased from 46.0±12.7 to 29.2±15.1 points (p<0.001) in combination with an increase in the plasma concentration of magnesium to 0.79±0.23 mmol/l; women's satisfaction with their physical, psychological, social well-being increased (from 21.1±4.5 to 26.2±3.5 points; from 24.8±4.9 to 28.1±4.4 points, and from 9.3±2.7 to 11.0±2.8 points, respectively; p<0.001); self-perception increased from 18.2±3.7 to 22.2±3.6 points. Thus, there was a significant decrease in the severity of MD and a significant improvement in QoL according to WHOQOL-BREF, which is important in the rehabilitation of such patients.Conclusion. The profile of patients with MS and surgical menopause receiving MHT, including the period of recovery after radical surgical treatment of reproductive cancer, is characterized by MD and decreased QoL. It seems effective to introduce MD correction into the complex rehabilitation program of such patients. It is necessary to conduct further studies to improve the rehabilitation measures in this cohort of patients.

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Surgical and natural menopause is often associated with depression symptoms. Along with the postpartum period, perimenopause is a “window of vulnerability” for depression development, because decline in estrogen level accounts for extinction of reproductive function, emotional disorders, genitourinary menopausal syndrome, which are combined with non-endocrine risk factors, such as decreasing income levels, low social support, and stress. Although a direct relationship between blood estrogens level and depression has not been demonstrated, the relation between menopause symptoms and depression has been proven, i.e., the symptoms of menopause can be considered as risk factors. Here, we summarizes the current view on the correct counseling and routing of menopausal women with depression symptoms in primary health care facilities, the principles of managing patients with risk factors, including genitourinary menopausal syndrome, as well as methods of rehabilitation and informational support. This will aid to improve the quality of medical care for such patients.