Menopause is a woman’s journey through the transitional period of life. Along with estrogen deficiency, age-related changes in this period include relative hyperandrogenism and reactivation of renin-angiotensin-aldosterone system (RAAS). These processes can lead to both the manifestation of clinical estrogen-deficient symptoms and the increase in metabolic disorders and cardiovascular diseases. The task of every obstetrician-gynecologist is to provide appropriate professional advice on issues related to the specified period. To date, prescribing MHT in postmenopausal women, along with the mandatory compliance with a healthy lifestyle, is consistent with the general principles of maintaining women’s health and improving the quality of life. The authors of this work provide an overview of possibilities for MHT for the treatment and prevention of conditions associated with estrogen deficiency in menopause.

Диеногест-высокоэффективное средство для лечения основных болевых симптомов эндометриоза (хронической тазовой боли, диспареунии и дисменореи) и профилактики рецидива заболевания с высоким профилем безопасности и хорошей переносимостью, что позволяет назначать его с целью долгосрочной терапии заболевания. В пользу выбора именно указанного прогестагена свидетельствуют новейшие данные, отражающие всестороннее воздействие на различные звенья патогенеза заболевания.

О.И. ЛИСИЦЫНА, Е.Г. ХИЛЬКЕВИЧ, д�м�н�Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им� акад� В�И� Кулакова Минздрава России, Москва ПРЕДМЕНСТРУАЛЬНЫЙ СИНДРОМ НОВЫЕ ВОЗМОЖНОСТИ ТЕРАПИИПредменструальный синдром (ПМС) -сложный патологический симптомокомплекс, проявляющийся различными нейропсихическими, вегетативно-сосудистыми и обменно-эндокринными нарушениями, который влияет на качество жизни пациенток и снижает их работоспособность. Лечение ПМС начинают с подбора диеты, коррекции режима труда и отдыха, максимального снижения психоэмоциональ-ных нагрузок. С целью медикаментозного воздействия используют гормональную терапию, психотропные препараты, нестероидные противовоспалительные препараты, мочегонные, растительные и гомеопатические препараты, витамино-терапию. Наиболее патогенетически обоснованной является гормональная терапия. Использование комбинированных оральных контрацептивов, обогащенных фолатами, в качестве терапии ПМС оказывает дополнительное эффективное воздействие на нервную систему, способствует стабилизации центральных нейрорегулятор-ных механизмов, а также снижению выраженности эмоционально-аффективных симптомов и когнитивных нарушений.Ключевые слова: предменструальный синдром, синдром предменструального напряжения, комбинированные оральные контрацептивы, дроспиренон, фолиевая кислота, фолаты, метафолин. O.I. LISITSYNA, E.G. KHILKEVICH, MD Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Health of Russia, Moscow PREMENSTRUAL SYNDROME NEW POSSIBILITIES OF THERAPY The premenstrual syndrome (PMS) is a complex pathological symptom manifesting itselft through variety of neuropsychiatric, vegetative-vascular and metabolic-endocrine disorders that affect the quality of life of patients and reduces their working ability.The treatment of PMS starts with the selection of diets, correction of the working and rest periods and the maximum reduction of psychoemotional stress. For the purpose of pharmaceutical effetc hormonal therapies, psychotropic drugs, nonsteroid antiinflammatory drugs, diuretics, plant and homeopathic drugs, vitamins are used. The most pathogenetically reasonable is hormonal therapy. The use of combined oral contraceptives enriched by folates as a way of PMS therapy has an additional effective impact on the nervous system, contributes to the stabilization of the central neuroregulatory mechanisms and reduces the expression of emotional and affective symptoms and cognitive disorders.

Taking into account that the frequency of abortions in Russia today remains quite high, the strategy of fertility regulation through the provision of contraceptive advice to women of various ages comes to the fore. It has been proven that combined oral contraceptives are the most effective method of preventing unwanted pregnancies. An innovative combination of oral contraceptives containing estradiol valerate (EV) and dienogest (DNG) dynamically provides effective inhibition of ovulation and sufficient cycle control. DNG/EV has high efficacy, acceptability and tolerability and can be successfully used in sexually active women in need of contraception, regardless of their age. Like any modern contraceptive, this drug possesses a whole arsenal of pronounced therapeutic possibilities, which can be used in real clinical practice. In addition, the combination of EV and DNG is highly effective in the therapy of menorrhagia. The percentage of patients who had successful treatment and resulted in a decrease in menstrual blood loss was high. The effectiveness of the drug is confirmed by the bleeding of withdrawal at the end of the first treatment cycle and continues to increase gradually with further administration.

The human immune system, which is in close connection with other organs and systems including the reproductive one, is required for the body’s defence against infections, as well as other external and internal factors. A balanced diet with a sufficient content of not only macro-, but also micronutrients is necessary for the normal function of the immune system. Various studies showed a relationship between the deficiency of various vitamins and trace elements and decreased activity of the immune system. Thus, the immune response can be impaired by malnutrition and trace element deficiency, which increases the body’s susceptibility to infectious factors. In its turn, the infectious process can lead to an increased demand for micronutrients, which is met by exogenous substances, and in case of not enough consumption of them – by endogenous reserves. Infections are one of the main factors deteriorating human reproductive health. Pelvic inflammatory diseases (PID) hold leading positions in the gynecological pathology pattern, and their prevalence does not show a downward trend. This literature review considers the impact of major infections on women’s reproductive health, presents data on the role of micronutrients in preventing infectious diseases and rehabilitating after them, as well as in preserving reproductive functions after infections. The importance of vitamin C, E, B vitamins, zinc, L-arginine for the preservation and restoration of women’s fertility is considered, and the results of studies on the issue are presented.