MRKH-INTEGRA An Author's Integrated Management Protocol for Mayer–Rokitansky–Küster– Hauser Syndrome

Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome is a congenital condition characterized by agenesis or severe hypoplasia of the uterus and the upper two-thirds of the vagina, with a normal 46,XX karyotype and preserved ovarian function. This author’s protocol integrates international recommendations (ESHRE/ESGE2013, ASRM MAC 2021, ACOG 2018) with two original components: (1) MRKH-MIND, a structured psychological support program adapted for Ukrainian-speaking patients and based on CBT-MRKH with additional ACT and somatic experiencing modules; and (2) MRKH-PELVI, a four-phase pelvic floor therapy program designed to prepare patients for vaginal dilation, reduce pelvic floor hypertonus, improve proprioception, andsupport sexual health. The protocol also introduces RPS-SCORE as a monitoring tool for reproductive pause syndrome. It defines multidisciplinary roles, integration points, timelines, outcomes, and limitations. The protocol is intended for specialized reproductive centers and requires prospective validation.