Mekan R. Orazov’s research while affiliated with Peoples' Friendship University of Russia and other places

One of the most controversial issues of modern gynecology is the study of the effect of combined oral contraceptives (COCs) on the endocrine-metabolic profile. Unfortunately, there are still hormonophobic prejudices in society about the adverse impact of COCs on body weight, carbohydrate metabolism, and lipid profile despite no evidence base for such judgments. Therefore, the purpose of the article is to analyze the effect of E4/drospirenone-based COCs on endocrine-metabolic parameters through the lens of evidence-based medicine.

Recurrent pregnancy loss (RPL) of unknown genesis is a complex condition with multifactorial origins, including genetic, hormonal, and immunological factors. However, the specific mechanisms underlying endocervical cell proliferation disorders in women with RPL remain inadequately understood, particularly concerning the role of microbiota and viral infections. The aim of this study was to investigate the mechanisms of endocervical cell proliferation disorders in women with RPL of unknown genesis by examining microbiota, human papillomavirus (HPV) typing, and the expression levels of key molecular biological markers, including p16/Ki-67, BCL-2, miR-145, and miR-34a. A prospective observational comparative study was executed on women with RPL and healthy pregnant controls with full ethical approval. Samples were collected for HPV typing and immunocytochemical analysis to evaluate the expression of p16, Ki-67, BCL-2, and the anti-oncogenic microRNAs (miR-145 and miR-34a). The expression of mRNA for the progesterone receptor (PGR-A) was also assessed, alongside local immune status markers, including proinflammatory T-lymphocytes (Th17/Th1) and regulatory CD4+ Tregs. Overexpression of p16, Ki-67, and BCL-2 was observed in 52.5% of women with RPL who had an ASC-US/LSIL cytogram, with the average double expression of p16/Ki-67 being three times higher than in the healthy pregnant group. A significant decrease in PGR-A mRNA expression in the endocervix of women with RPL was noted, accompanied by a dysregulated local immune status characterized by an increased prevalence of Th17/Th1 cells and a reduction in regulatory CD4+ Tregs. Additionally, the expression of miR-145 and miR-34a in the endocervix and endometrium of women with RPL significantly differed from the physiological pregnancy group, particularly in the context of high-risk HPV infection. The findings describe that disorders of endocervical cell proliferation in women with RPL of unknown genesis are associated with overexpression of specific molecular markers, impaired immune regulation, and altered microRNA profiles. These alterations may contribute to the pathophysiology of RPL, highlighting the need for further research into targeted interventions that could improve reproductive outcomes in affected individuals.

Pelvic organ prolapse (POP) has a considerable negative effect on the women’s quality of life. The rate of POP will grow due to population ageing (according to forecasts, by 46% by the year 2050). The global prevalence of obesity is increasing dramatically: according to the WHO forecasts, more than 50% of the Earth’s population (more than 4 billion people) will be overweight or obese by the year 2035. Obesity and dyslipidemia (elevated levels of triglycerides, low-density lipoprotein cholesterol; decreased levels of high-density lipoproteins) can trigger the development and progression of POP. However, this aspect of the POP pathogenesis is poorly understood. Aim: to expand the knowledge about the POP pathogenesis in patients with obesity and metabolic disorders. Methods. Analysis of the results of the studies published in the CochraneLibrary, PubMed, Science Direct, ELibrary digital libraries in 2010–2024 for the keywords “pelvic organ prolapse/пролапс тазовых органов”, “recurrence/рецидив”, “pathogenesis/патогенез”, “metabolic syndrome/метаболический синдром”, “abdominal obesity/абдоминальное ожирение”, “hypertriglyceridemia/гипертриглицеридемия”, “hypercholesterolemia/гиперхолестеринемия” was performed. Results. Coupled with the mechanical load caused by abdominal obesity, chronic systemic inflammation associated with metabolic syndrome, elevated levels of pro-inflammatory cytokines and activation of matrix metalloproteinases, as well as oxidative stress can result in weakening of the pelvic organ supportive structures, and microvascular dysfunction disturbes local hemodynamics, thereby contributing to the pelvic floor connective tissue remodeling processes. Conclusion. Qualitative studies involving large samples are necessary for better understanding of the pathogenetic mechanisms underlying the development of primary POP and POP recurrence, as well as for the development of the treatment approaches contributing to reducing the risk of progression. The management tactics for patients with POP associated with metabolic syndrome requires a multidisciplinary approach.

Obesity still remains a global and most urgent problem of the world’s public health system. Exponential growth of incidence all over the world has encouraged the World Health Organization (WHO) to declare that obesity is a global non-communicable pandemic of the 21st century. In the recent decades, a rapid increase in the prevalence of overweight and obesity that are inevitably associated with carcinogenic risk, including proliferative disorders (hyperplasia) and endometrial cancer, is reported globally. The today’s epidemiological data demonstrate that there is a strong correlation between obesity and endometrial hyperplasia (EH), which represent the associated clinical conditions based on many parameters (specifically, pathogenetic). The paper reports pathogenetic associations between obesity and EH, as well as modern strategies to overcome those based on the national and new international guidelines (2025).

High rate of recurrence after surgical correction remains the key problem of the pelvic organ prolapse (POP) treatment, while the key objective is the search for the ways to improve surgical techniques. Various surgical approaches, including minimally invasive, involving the use of mesh implants or native tissues have been developed, but neither patients, nor surgeons are satisfied with the results. Aim: to analyze available scientific data on the efficacy and safety of surgical correction methods in terms of genital prolapse recurrence. Methods. Analysis of scientific papers published in the ELibrary, PubMed, CochraneLibrary, Science Direct databases in 2010–2024 for the keywords “pelvic organ prolapse/пролапс тазовых органов”, “rectocele/ректоцеле”, “cystocele/цистоцеле”, “apical prolapse/апикальный пролапс”, “recurrence/рецидив”, “surgical treatment/оперативное лечение” was performed. Results. To date, no perfect surgical approach to treatment of POP has been developed; no optimal surgical procedures for correction of primary and recurrent POP allowing one to avoid the disease progression have been proposed. A comprehensive personalized approach based on thorough assessment of the pelvic floor condition taking into account all the existing risk factors of primary POP or new disease progression factors in case of recurrence is the key to reducing the POP recurrence rate. Conclusion. Verification of fascial defects during preoperative and intraoperative periods is believed to be critical for improvement of the POP surgical treatment outcomes. Sufficient extent of surgical intervention, elimination of all fascial defects, optimal use of MESH technologies might improve anatomical and subjective operative results, as well as reduce the risk of recurrence. The use of synthetic implants in a number of studies has proven to be effective, regardless of the ongoing discussions about safety of such methods. It is necessary to continue the research on a large sample, since it will make it possible to improve the long-term treatment outcomes.

Family planning is a fundamental concept for building and development of society in the 21st century. The beliefs that developed over the last century and the priorities that changed resulted in the ecological and reproductive dissonance, the main consequences of which are the increasing age at first birth, decreasing total fertility rate, and increasing incidence of gynecological diseases. Hormonal contraception is one of the main family planning methods, which makes it possible to build up reserves for women’s reproductive health preservation and effectively control reproductive function. In turn, combined oral contraceptives (COCs) represent the most convenient method. Recently, an innovative estetrol/drospirenone-based COC, which, according to a number of studies, is among the most versatile and favorable in terms of extracontraceptive benefits, went on sale in the Russian Federation. In this regard, it is necessary to analyze the available data and create a concise summary of the proven advantages of this COC in the context of a number of characteristics.

Modern trends of human lifestyle changes contribute to the unparalleled increase in the incidence of some occupational diseases. And, despite the development of modern technologies and such a pronounced leap in social development, obesity remains an unresolved issue of mankind. Today, obesity represents an overwhelming problem that needs to be solved immediately and covers many medical specialties, including gynecology. In this regard, the paper is aimed to consider epidemiological features of obesity as a global issue and report the key touchpoints with modern gynecology and key approaches to clinical management of patients of this cohort.

Genitourinary syndrome of menopause still represents one of the most pressing unresolved issues of modern gynecology. High prevalence and the data suggesting a marked decline in the quality of life in general and sexual life in particular in patients of this cohort demonstrate the need to develop effective clinical management programs. The review provided considers the key aspects of genitourinary syndrome of menopause as a medical and social problem, reports modern approaches to clinical management in the wake of new international guidelines.

In recent decades, the attention of the medical community has increasingly focused on the problems associated with ovarian tumors, especially on the differentiation/difference between borderline tumors and ovarian cancer. These two conditions not only have different outcomes in terms of prognosis, but also require different approaches to diagnosis and treatment, which makes them the subject of careful study and analysis. This review examines the key aspects related to borderline ovarian tumors, their classification, clinical picture and management tactics, taking into account domestic and international recommendations.

Currently, the conditions associated with iron deficiency are one of the most pressing unresolved issue of anti-aging medicine. Female patients of late reproductive age and perimenopausal/postmenopausal patients represent the most “vulnerable cohorts” in terms of iron deficiency realization. To date, both short-term and long-term effects of iron deficiency associated with adverse consequences for health and the quality of life have been proven. The review considers the key determinants of iron deficiency development in female patients of late reproductive age and perimenopausal/postmenopausal patients, as well as clinical management of such patients based on domestic and international guidelines.