Chronic pelvic pain (HTB) remains a relevant multidisciplinary problem. Its symptoms are the result of interaction between psychological factors and dysfunction of the immune, neurological and endocrine systems. HTB is a serious problem for women. Approximately 14% of women experienced HTB at least once in their lives. HTB is grueling and related to significant costs and incidence, and its etiology is multifactorial, which often complicates medical treatment and treatment of associated symptoms. Best practice guidelines recommend an interdisciplinary and biopsychosocial approach to treatment. However, the problem of HTB requires further comprehensive study and expanding possible methods of effective pain control and improving the quality of life of the female population. The article systematizes literary sources on the genesis of pain, the principles of classification, diagnostics and management.

The aim of the study was to evaluate the clinical efficacy of an integrated approach to therapy and prevention of relapse of bacterial vaginosis in women of reproductive age with overweight and obesity. We examined 60 women of reproductive age (19–39 years) with overweight and obesity (BMI+30±4.2) and a verified diagnosis of recurrent bacterial vaginosis (real-time PCR, diagnostic system Femoflor–16). The effectiveness of treatment of bacterial vaginosis in overweight and obese women was 94.0% due to the rapid elimination of the pathogen by a single dose of 2 g of the drug group 5-nitroimidazoles Secnidox and macrolide 16-membered antibiotic with bactericidal mechanism Doramycin (World Medicine, United Kingdom). Combination prolonged therapy with the multi-strain probiotic Brevelac and the natural drug Reitoil increased the remission period of bacterial vaginosis to 6 months in 91.0% of this group of patients. Keywords: bacterial vaginosis, overweight, obesity, therapy, remission.

ВСТУПДиспластичні ураження епітелію шийки мат-ки (ДЕШМ) є важливою медико-соціальною проблемою, оскільки недосконала діагности-ка та неефективне лікування даної патології призводять до її трансформації в рак шийки матки (РШМ), який посідає в Україні друге міс-це серед причин смертності жінок від злоякіс-них новоутворень [1,2].Важливим напрямком у профілактиці РШМ є своєчасна та ефективна верифікація патології епітелію ШМ із застосуванням цитологічно-го, цитоморфологічного методів обстеження, кольпоскопії, оцінки вірусно-бактеріальної контамінації статевих шляхів, результатів мор-фологічного та імуногістохімічного дослід-жень [3][4][5]. АНАЛІЗ ЛІТЕРАТУРНИХ ДАНИХ ТА ПОСТАНОВКА ЗАВДАННЯ ДОСЛІДЖЕННЯВибір тактики лікування ДЕШМ та гіперпро-ліферативних захворювань тіла матки (ГЗТМ), застосування консервативного чи хірургічно-го лікування, вибір препарату гормональної терапії залежить від віку пацієнтки, її бажання реалізувати репродуктивну функцію, наявності попередніх хірургічних втручань на органах малого таза, супутньої екстрагенітальної пато-логії. Рання діагностика патологічних змін епі-телію ШМ та ефективне їх лікування є запору-кою можливості реалізації органозберігаючого лікування лейоміоми матки (ЛМ), ендомет ріозу матки та їхнього поєднання [6][7][8][9].Тактика ведення пацієнток із ДЕШМ стала обережнішою, з дотриманням принципів не-обхідності та достатності в застосуванні тих чи інших методів лікування. Поряд із цим на сьо-годні відсутні чіткі рекомендації щодо опти-мального вибору консервативних та опера-тивних підходів у лікуванні ДЕШМ на тлі ГЗТМ. Дискусійними залишаються питання безпеч-ності застосування тривалої гормональної те-рапії в даного контингенту жінок.Мета роботи: підвищення ефективності лі-кування ДЕШМ на тлі ГЗТМ у жінок репродук-тивного віку. МАТЕРІАЛИ ТА МЕТОДИПроаналізовані результати лікування 90 жі-нок репродуктивного віку з ДЕШМ на тлі ГЗТМ. Жінки основної групи (45 пацієнток) отриму-вали розроблений нами діагностично-ліку-

Annotation. The purpose of the work is to analyze the gynecological, somatic, reproductive history, as well as to determine the risk factors and etiopathogenetic factors of miscarriage on the background of endometritis. We examined 98 women of childbearing age who applied to the Innomed Clinic in Vinnytsia during 2019–2020. Patients were divided into two groups: the main group – 68 women (the average age was 27.25±0.29) with habitual miscarriage and chronic endometritis; control group – 30 re-pregnant women (the average age was 26.74±0.18) without previous pregnancy loss. Statistical processing, as well as analysis of the obtained data was performed using the program “Microsoft Excel” using the methods of mathematical statistics. Statistical evaluation was performed using the Student’s test. The obtained results were considered reliable at a reliability factor p <0.05 (95% significance level). Distribution of patients of the main group by number of reproductive losses was as follows: twice – 45 women, three times – 15 women, 4 and more – 8 women. Structural distribution of pregnancy losses in women of the main group (n=68) was next: miscarriage – 41, missed abortion – 21, anembryonic pregnancy – 6. The number of reproductive losses in the first trimester was 71.7%. Reproductive losses detected during 13–22 weeks reached 28.3%. Concomitant impressions of extragenital organs and systems were found in 46 (67.6%) women of the main group and 7 (23.3%) women of the control group. The leader of somatic morbidity was endocrine pathology. Among gynecological pathology, chronic endometritis was observed in 100% (n = 68) of the examined women of the main group. In addition, 55 patients (80.9%) of this group in the structure of gynecological pathology had other lesions, among which a significant indicator belongs to chronic salpingo-oophoritis (22 (32.4%)) and various menstrual disorders (18 (26.5%)). The vast majority of women in the main group had a history of instrumental revision of the walls of the uterine cavity for various pregnancy losses in the anamnesis (28 (41.2%)). That is why the qualitative analysis of clinical data of women with habitual miscarriage and chronic endometritis is an important area of research, as it allows to carry out adequate treatment and prevention measures at the stage of pre-pregnancy training.

Chronic endometritis is a clinical and morphological syndrome, which under the influence of an infectious agent contributes to the violation of cyclic biotransformation and reciprocity of the endometrium. In the diagnosis of gynecological pathology, in particular chronic endometritis, or habitual miscarriage on the background of chronic endometritis, ultrasonography is a mandatory, non-invasive and highly specific method of research. The aim of the study was to assess the anatomical and functional condition of the pelvic organs in women with habitual miscarriage and chronic endometritis using ultrasound (ultrasound and Doppler) criteria. We examined 98 women of childbearing age who applied to the Inomed clinic in the city of Vinnytsia during 2019-2020. Patients were divided into two groups: the main group – 68 women with habitual miscarriage and chronic endometritis; control group – 30 re-pregnant women without previous pregnancy loss. Initially, ultrasound examination (ultrasound) of the pelvic organs was performed on day 5-7 of the menstrual cycle, and to monitor folliculogenesis, the study was repeated on day 13-17 of the cycle. One of the main signs of chronic endometritis is the heterogeneity of the structure of the endometrium, which was found in the vast majority of examined patients of the main group (80.88% at n=68). When determining the thickness of the endometrium, two diametrically opposite processes were established, namely: atrophy (39.71% at n=68) and atypical glandular hyperplasia (22.05% at n=68). In the second half of the menstrual cycle there was a significant thinning of the endometrial layer <0.6 cm. In the control group during the ultrasound examination revealed the following disorders: increased uterine peristalsis, dilation of the arcuate plexus, the heterogeneity of the subendometrial layer, and when re-ultrasound took into account the data of folliculogenesis. Follicular cysts were detected in 10.3% of cases in the main group and 3.3% in the control group of women. At the time of re-ultrasound in each ovary was observed 5-8 antral follicles (the size of which ranged from 6.8 mm to 11.5 mm) with the presence of one dominant, the size of which ranged from 18.2 to 23.4 mm. In order to increase the informativeness of ultrasound, Doppler was additionally performed. Thus, ultrasonography is a highly specific method for determining the anatomical and functional characteristics of the pelvic organs, in particular the pathology of the endometrium in women with habitual miscarriage. The main ultrasound characteristics of chronic endometritis, as one of the causes of reproductive losses, are changes in endometrium structure, thickness, the presence of additional structures (polyps) and fluid component. Informativeness of ultrasound examination of structural changes in the endometrium in chronic endometritis is complemented by Doppler characteristics of blood flow in the basal and spiral arteries of the uterus.