In this article, we present the results of organ-preserving treatment applied in 24 patients of reproductive age with atypical endometrial hyperplasia or early-stage endometrial cancer. All of them would like to preserve their reproductive potential. Thirteen women with atypical endometrial hyperplasia were treated with the combination of six intramuscular injections of 3.75 mg gonadotropin-releasing hormone agonist (GnRHa)--leuproreline acetate depot every 4 weeks. After the third injection of 3.75 mg of leuproreline acetate, the levonorgestrel intrauterine hormonal system containing 52 mg levonorgestrel (Mirena®, Bayer, Germany) was inserted for at least 6 months. In 11 women with stage IA well-differentiated endometrial adenocarcinoma, hormonal therapy included nine intramuscular injections of 3.75 mg of GnRHa every 4 weeks. After the third injection of 3.75 mg of GnRHa, we also inserted a GnRH-IUS (Mirena®) for at least 12 months. This type of therapy was effective for all these patients and may be offered to be used as an alternative to surgery in women with atypical endometrial hyperplasia or early stage 1A well-differentiated endometrial cancer in women of reproductive age. Three women with endometrial cancer became pregnant and two of them delivered at term and one has an ongoing pregnancy.

Endometriosis is among the prevalent gynecological diseases and diagnosed in 10% of women of reproductive age. Endometriosis/adenomyosis is becoming increasingly a health-social problem, which is associated with severe clinical manifestations and recurrent disease which has a negative effect on quality of life, women ability to work and her reproductive function. This article presents modern approaches of drug therapy to treat severe forms of adenomyosis. We have reviewed recent major studies in the field of surgical treatment of this disease, analyzed the main stages of disease progress and the results of our surgeries. Here, we are presenting our own results of long-term post-operative hormonal therapy and complex medical treatment.

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Красноярский государственный медицинский университет имени профессора В.Ф. Войно-Ясенецкого, Красноярск 660022, Российская Федерация Резюме. В статье проведен научный обзор литературы, посвященный одной из распространенных проблем репродуктивной гинекологии, вопросу этиологической роли миомы матки в развитии женского бесплодия. В обзор включены 36 зарубежных и 17 отечественных источников по данной теме. На основании анализа результатов современных исследований в обзоре представлены основные причины развития бесплодия в зависимости от величины и локализации миоматозных узлов. Приведены данные об эффективности хирургических и фармакологических методов терапии при миоме матки. Несмотря на многообразие исследований, посвященных бесплодию, ассоциированному с миомой матки, данная проблема до настоящего времени остается нерешенной. Установлено, что отсутствует консенсус как в отношении патогенеза заболевания, так и в выборе оптимальных методов лечения для восстановления репродуктивной функции у женщин с миомой матки. Ключевые слова: миома матки, бесплодие, медикаметозное лечение, миомэктомия, гистерорезектоскопия, ангиогенез, селективные модуляторы рецепторов прогестерона. Конфликт интересов. Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с публикацией настоящей статьи. Для цитирования: Цхай ВБ, Григорян ЭС, Костарева ОВ, Бадмаева СЖ. Миома матки и бесплодие: этиология, патогенез, современные принципы лечения (обзор литературы). Сибирское медицинское обозрение. 2019;(4):25-33.Abstract. The article presents scientific review of literature devoted to one of the most common problems in reproductive gynecology -problem of etiological role of uterine fibroids in women's infertility. The review includes 36 foreign and 17 domestic sources on the subject. The main causes of infertility, depending on fibroids size and location, are presented in the review according to the analysis of current research. The data on the effectiveness of surgical and pharmacological therapies for uterine fibroids are given. Despite the variety of studies on infertility, associated with uterine myoma, the problem is still unsolved. It has been stated that there is no consensus both in relation to the pathogenesis of the disease and in choice of better treatment methods for reproductive function recovery in women with uterine fibrosis.

The presented clinical example convincingly demonstrates the efficacy of dydrogesterone (30 mg) in the prevention of severe preeclampsia in a high-risk patient (early development of preeclampsia and preterm Cesarean section in her first pregnancy, arterial hypertension). This case suggests using dydrogesterone as an option to prevent preeclampsia, as previously shown in a prospective randomized study.