Гинекология. Планирование семьи и репродуктивные технологии

ГИНЕКОЛОГИЯ 
ПЛАНИРОВАНИЕ СЕМЬИ 
И РЕПРОДУКТИВНЫЕ ТЕХНОЛОГИИ
УЧЕБНО-МЕТОДИЧЕСКОЕ ПОСОБИЕ
Под редакцией Е.А. Эйныш
 
Москва 
Гомель
 
ИНФРА-М 
ГомГМУ
2025

УДК 618.1+316.362.4(075.8)=111
ББК 57.1я73=432.1
 
Г49
А в т о р ы:
Эйныш Е.А., Лызикова Ю.А., Корбут И.А., Лашкевич Е.Л., Кравченко C.С., Маевская М.В.
Р е ц е н з е н т ы:
кафедра акушерства и гинекологии Гродненского государственного медицинского университета;
Подгорная А.С., кандидат медицинских наук, заведующий отделением гинекологии Республиканского научно-практического центра 
радиационной медицины и экологии человека
 
Г49
 
 
Гинекология. Планирование семьи и репродуктивные технологии : 
учебно-методическое пособие / Е.А. Эйныш, Ю.А. Лызикова, И.А. Корбут [и др.] ; под ред. Е.А. Эйныш. — Москва : ИНФРА-М ; Гомель : 
ГомГМУ, 2025. — 240 с.
ISBN 978-5-16-020273-0 (ИНФРА-М, print)
ISBN 978-5-16-112818-3 (ИНФРА-М, online)
ISBN 978-985-588-357-0 (ГомГМУ)
В учебно-методическом пособии по дисциплине «Акушерство и гинекология» содержатся современные систематизированные сведения 
об анатомо-физиологических особенностях женского организма, методах 
обследования гинекологических пациентов, клинических симптомах гинекологических заболеваний, методах их диагностики, лечения и профилактики. Отдельная глава посвящена вопросам планирования семьи и методам 
контрацепции, проблемам бесплодного брака и современным репродуктивным технологиям.
Предназначено для студентов 5–6 курсов учреждений высшего образования, обучающихся по специальности «Лечебное дело» на английском 
языке.
УДК 618.1+316.362.4(075.8)=111
ББК 57.1я73=432.1
ISBN 978-5-16-020273-0 (ИНФРА-М, print)
ISBN 978-5-16-112818-3 (ИНФРА-М, online)
ISBN 978-985-588-357-0 (ГомГМУ)
© Гомельский государственный 
медицинский университет, 
2024

CONTENTS
List of abbreviations .............................................................................. 8
Unit 1. Organization of the hospital service and medical
care for women and children. Anatomy and physiology
of the female genital organs ....................................................................10
1.1. Organization of the hospital service of gynecological patients.
Тhe organization of medical care for women and children .......................10
1.2. Anatomy and physiology of the female genital organs 
.................15
1.3. Physiological mechanisms of protection against
pathogenic organisms and inflammatory diseases
of the genital organs ..................................................................................20
References 
............................................................................................21
Unit 2. Methods of examination in gynecologic patients 
................22
2.1. Methods of examination in gynecologic patients.
Main clinical symptoms of gynecological disorders .................................22
2.2. Instrumental methods of examination in gynecology 
...................25
2.3. Ultrasonography in gynecology 
....................................................26
2.4. Endoscopic techniques in gynecology ..........................................27
2.5. Methods of evaluation of ovarian function (functional
diagnostic tests, the level of hormones) 
.....................................................34
References 
............................................................................................38
Unit 3. Physiology and pathology of menstrual cycle 
.....................39
3.1. Menstrual cycle. Characteristics of the normal 
menstrual cycle ..........................................................................................39
3.2. Ovarian cycle. Endometrial cycle. The biological effects
of estrogen, progesterone and androgen ....................................................39
3.3. Levels of regulation of the reproductive system. Feedback loops .....43
3.4. Classification of menstrual dysfunction. Amenorrhea.
Primary and secondary amenorrhea. Etiology, diagnosis, treatment .........46
3.5. Abnormal uterine bleeding. Classification, diagnosis, treatment 
......54
3.6. Dysmenorrhea. Etiology, pathogenesis, clinical
manifestations, diagnosis, treatment ..........................................................63
References 
............................................................................................66
3

Unit 4. Neuroendocrinal syndromes ................................................67
4.1. Premenstrual syndrome. Etiology, pathogenesis,
clinical manifestations, diagnosis, treatment .............................................67
4.2. Polycystic ovary syndrome. Etiology, pathogenesis,
classification, clinical manifestations, diagnosis, treatment ......................69
4.3. Congenital adrenal hyperplasia. Clinical features,
diagnosis, treatment ...................................................................................72
4.4. Hyperprolactinemia. Etiology, pathogenesis, clinical
manifestations, diagnosis, treatment ..........................................................73
4.5. Sheehan’s syndrome (postpartum panhypopituitarism).
Etiology, pathogenesis, clinical features, diagnosis, treatment 
..................75
4.6. Climacteric syndrome. Etiology, pathogenesis, clinical
manifestations, diagnosis, treatment ..........................................................77
References 
............................................................................................84
Unit 5. Premalignant lesions of the endometrium and cervix .......86
5.1. Pathology and classification of endometrial hyperplastic
processes. Clinical features and methods of diagnostic of endometrial
hyperplastic processes. Conservative and surgical treatment ....................86
5.2. Benign diseases of the cervix. Clinical manifestations,
diagnosis, treatment ...................................................................................91
5.3. Premalignant lesions of the cervix. Clinical manifestations,
diagnosis, treatment ...................................................................................96
References ......................................................................................... 107
Unit 6. Benign tumors of uterus, ovaries and breast.
Endometriosis 
..........................................................................................108
6.1. Uterine fibroid. Etiology, pathogenesis, classification.
Clinical manifestations, diagnosis, treatment ..........................................108
6.2. Benign ovarian tumors. Etiology and classification 
of ovarian tumors (WHO). Clinical features, diagnosis, management ......113
6.3. The endometriosis. Definition of the endometriosis.
Basic characteristics of disease. The theories of endometriosis origin .......117
6.4. Clinical features and diagnosis of various forms
of endometriosis: uterine endometriosis, ovarian endometriosis,
endometriosis of cervix, extragenital endometriosis ...............................119
4

6.5. Modern methods of treatment of endometriosis .........................122
6.6. Breast diseases. Etiology, pathogenesis,
clinical manifestations, diagnosis, treatment ...........................................125
References 
..........................................................................................129
Unit 7. Pelvic inflammatory diseases 
..............................................130
7.1. Nonspecific inflammatory diseases of the lower part
of the genital organs: vulvitis, bartholinitis, cervicitis 
.............................130
7.2. Nonspecific inflammatory diseases of the upper part
of the genital organs: endometritis, salpingitis, salpingoophoritis...........134
7.3. Gonorrhea. Etiology, pathogenesis, clinical
manifestations, diagnosis, treatment, prophylaxis ...................................141
7.4. Genital herpes. Etiology, pathogenesis, clinical
manifestations, diagnosis, treatment, prophylaxis ...................................142
7.5. Vulvovaginal candidiasis. Etiology, pathogenesis,
clinical manifestations, diagnosis, treatment, prophylaxis ......................145
7.6. Trichomoniasis. Etiology, pathogenesis, clinical
manifestations, diagnosis, treatment, prophylaxis ...................................147
References 
..........................................................................................150
Unit 8. Congenital malformations of female genitalia.
Premature and delayed puberty. Pelvic organs prolapse 
...................151
8.1. Congenital malformation of the hymen and vagina.
Clinical features, diagnosis, methods of treatment ..................................151
8.2. Congenital malformation of the uterus. Clinical features,
diagnosis, surgical treatment 
....................................................................154
8.3. Congenital malformation of the fallopian tubes
and ovaries. Clinical features, diagnosis 
..................................................158
8.4. Premature (precocious) puberty. Classification.
Clinical features, diagnosis, treatment .....................................................160
8.5. Delayed puberty. Classification. Clinical features,
diagnosis, treatment .................................................................................164
8.6. Pelvic organ prolapse. Classification, etiology,
pathogenesis, clinical features .................................................................167
8.7. Pelvic organ prolapse. Diagnosis, treatment, prevention 
............170
References 
..........................................................................................174
5

Unit 9. Emergency care in gynecology. Preoperative
management, postoperative care. Postoperative 
complications, prophylaxis 
....................................................................175
9.1. Ectopic pregnancy. Classification. Etiology, pathogenesis,
clinical manifestations, diagnosis, treatment, prophylaxis ......................175
9.2. Ovarian apoplexy. Etiology, pathogenesis, clinical
manifestations, diagnosis, treatment ........................................................179
9.3. Torsion of ovarian tumors. Etiology, pathogenesis,
clinical manifestations, diagnosis, treatment, prophylaxis ......................181
9.4. Incomplete abortion. Etiology, pathogenesis,
clinical features, diagnosis, treatment 
......................................................183
9.5. Preoperative management in gynecology ...................................184
9.6. Postoperative care of gynecological patients 
..............................188
9.7. Postoperative complications .......................................................190
References 
..........................................................................................193
Unit 10. Infertility. Family planning and reproductive
technologies. Contraception ..................................................................194
10.1. Neuroendocrinology in relation to reproduction.
Diagnosis of infertility .............................................................................194
10.1.1. Control of menstrual cycle .................................................194
10.1.2. Hypothalamic-pituitary-ovarian axis and control
of the menstrual cycle ..............................................................................196
10.1.3. Ovarian steroidogenesis .....................................................198
10.1.4. Embryonic and fetal development .....................................200
10.1.5. Endometrial receptivity, method of diagnosis 
......................201
10.1.6. Reproductive imagining: pelvic ultrasonography,
saline infusion sonography, hysterosalpingography ................................202
10.2. Infertility. Treatment .................................................................203
10.2.1. Causes of female and male infertility 
................................203
10.2.2. Organization of examination of infertile married couple .....204
10.2.3. Tests for ovulation .............................................................207
10.2.4. Ovarian reserve testing 
......................................................209
10.2.5. Basic principles of treatment of male and female
infertility ................................................................................................210
10.2.6. Methods of conservative treatment of female
infertility. Ovarian stimulation 
.................................................................211
6

10.2.7. Methods of surgical treatment of infertility ......................212
10.3. Assisted reproductive technologies 
...........................................215
10.3.1. Assisted reproductive technology: history, social aspects 
.....215
10.3.2. Assisted reproductive technology:
intrauterine insemination ........................................................................215
10.3.3. Assisted reproductive technology: ICSI ............................219
10.4. Methods of termination of pregnancy 
.......................................221
10.4.1. Social and medical indications for termination
of pregnancy 
.............................................................................................221
10.4.2. Methods of termination of pregnancy up
to 12 weeks, complications ......................................................................223
10.4.3. Methods of termination of pregnancy in the period
from 12 to 22 weeks, complications ........................................................224
10.5. Hormone therapy in gynecology 
...............................................225
10.5.1. The main principles of hormone therapy:
inhibition of ovulation, stimulation of ovulation, hormone
replacement therapy .................................................................................225
10.5.2. Hormone replacement therapy: groups of drugs,
indications, contraindications ..................................................................228
10.6. Methods of contraception. Classification.
Indications and contraindications. Complications of contraception ...........230 
10.6.1. Hormonal contraception: classification .............................233
10.6.2. Intrauterine devices: classification,
the mechanism of contraceptive action, contraindications,
complications ...........................................................................................234
References 
..........................................................................................237
7

LIST OF ABBREVIATIONS
ACTH  – adrenocorticotropic hormone
AFC  
– antral follicle count  
AMH  
– anti-Müllerian hormone 
ART  
– artificial reproductive technologies
AUB  
– abnormal uterine bleeding 
BBT  
– basal body temperature 
β-hCG  – beta-human chorionic gonadotropin
BMI  
– body mass index
CCCT  
– Clomiphene Citrate Challenge Test
CIN  
– cervical intraepithelial neoplasia
CMVI  
– cytomegaloviral infection
CRH  
– corticotropin releasing hormone
CT  
– computerized tomography
D&C  
– dilation and curettage 
DES  
– diethylstilbestrol 
DHEA  – dehydroepiandrosterone
DSD  
– disorders of sex development
DVT  
– deep vein thrombosis 
EMB  
– endometrial biopsy
ESR  
– erythrocyte sedimentation rate
FSH  
– follicle-stimulating hormone
GIFT  
– gamete intrafallopian transfer
GnRH  
– gonadotropin-releasing hormone
HPV  
– human papillomavirus 
HSIL  
– high-grade squamous intraepithelial lesions 
HRT  
– hormone replacement therapy 
HSG  
– hysterosalpingography
IVF  
– in-vitro fertilization 
IUD  
– intrauterine device
IUI  
– intrauterine insemination
LH 
– luteinizing hormone
LOD  
– laparoscopic ovarian drilling 
LSIL  
– low-grade squamous intraepithelial lesions
MRgFUS  
– magnetic resonance-guided focused ultrasound
8

MTP  
– medical termination of pregnancy
MRI  
– magnetic resonance imaging
OHIA  
– operative hysteroscopy intravascular absorption syndrome
PID  
– pelvic inflammatory disease
PCOS  
– polycystic ovarian syndrome 
PE  
– pulmonary embolism 
PIF  
– prolactin inhibitory factor
PMS  
– premenstrual syndrome 
POP  
– pelvic organ prolapse
SIS  
– saline infusion sonography  
SHG  
– sonohysterography 
STI  
– sexually transmitted infections
STH  
– somatotropic hormone 
TSH-test – thyroid stimulating hormone test
TRH 
– thyrotropin releasing hormone
TVS  
– transvaginal sonography
UMI  
– urogenital mycoplasma infection 
VTE  
– venous thromboembolism 
ZIFT  
– zygote intrafallopian transfer
9

UNIT 1
ORGANIZATION OF THE HOSPITAL 
SERVICE AND MEDICAL CARE FOR WOMEN 
AND CHILDREN.
ANATOMY AND PHYSIOLOGY
OF THE FEMALE GENITAL ORGANS
1.1. Organization of the hospital service of gynecological 
patients. Тhe organization of medical care for women and 
children
It is a system of public and private measures aimed at preserving and 
strengthening the health of women and children, creating optimal conditions 
for a woman to perform her most important function – the birth and upbringing 
of a healthy child. 
Perinatal care is a system of organization of medical care for a woman, 
fetus and newborn, including the pre-pregnancy period, pregnancy, childbirth 
(delivery) and the postpartum period. The provision of perinatal care is based 
on the principle of equal accessibility of specialized medical care from the 
standpoint of its justification and effectiveness and should be carried out at 
the level where conditions are created for maximum preservation of the life 
and health of a pregnant woman, a maternity hospital and a newborn child.
The multi-level system of providing perinatal care is defined by the 
Order of the Ministry of Health of the Republic of Belarus № 966 (dated 
09.08.2019) and represents a complex of organizational and therapeutic and 
diagnostic measures aimed to improve the efficiency of management and 
coordination of the activities of healthcare organizations providing medical 
care to pregnant women, women in labor, maternity hospitals, newborns, 
children, reducing maternal and infant losses, rational use of human, material 
and information resources [1].
The main goal of the multi-level system of perinatal care is to provide 
accessibility for any woman and newborn of all components of the current 
system of perinatal care.
Tasks and functions of a multi-level system of perinatal care:
• to ensure accessibility, phasing and continuity in the provision 
 
of medical care to women and children using modern medical technologies;
10