Alexandra Feodorovna (Alix of Hesse), the wife of Nicholas II of Russia, was the last Russian empress.
Among the most famous tsarinas of this period were six or seven wives of Ivan the Terrible, who were poisoned by his enemies, killed or imprisoned by him in monasteries.
This deprived Russia of the benefits of royal intermarriage with European monarchs, but protected from inbreeding, as well as from the political influence of foreign princesses (Catholic or Protestant).
The only foreign wife of a Russian tsar in this early era (except Mnishek) was Maria Temryukovna, a Circassian princess, who converted to Orthodoxy.
When the Second Bulgarian Empire was created in 1185 the rulers again adopted the title tsar and their consorts were therefore called tsarinas.
She married Dušan's son, Tsar Stephen Uroš V of Serbia, sometime in the 1350s, and ruled until the Serbian empire's demise in 1371.