Effectiveness of long-term hormone therapy for endometriosis after surgical treatment
Objective. To evaluate the effectiveness of long-term dydrogesterone therapy for 12 months after surgical treatment of external genital endometriosis in reducing the intensity of endometriosis-associated pain, improving the quality of life, overcoming infertility and preventing the recurrence of the disease. Materials and methods. The study included 51 patients aged 21 to 43 years (median age 32.23±4.0 years) with endometriosis which was confirmed laparoscopically and histologically; the patients experienced endometriosis-associated pain and received hormone-modulating therapy with dydrogesterone in the postoperative period. After 12 months of combined treatment, the dynamics of pain relief, improvement in the quality of life, and pregnancy rate in infertile women were evaluated. Histological and immunohistochemical studies were used to determine the characteristics of endometrioid infiltrates and intact peritoneum in patients with pelvic pain of varying intensity. Results. After 12 months of combined treatment of endometriosis (surgical and dydrogesterone therapy), there was a statistically significant decrease in pain intensity (NRS, points): the intensity of dysmenorrhea before surgery was rated as 8 (6;9), after surgery it scored 1 (0;2), the intensity of dyspareunia – 5 (2;7) and 0 (0;0.5), chronic pelvic pain – 6 (1;6) and 1 (0;2), respectively (p<0.0001). There was a statistically significant improvement in the quality of life and satisfaction with sexual life (p<0.05), as well as high pregnancy rate in patients with infertility: 10 (62%) patients became pregnant spontaneously, and 3 (19%) patients became pregnant using ART. Conclusion. The study proves the need for combined surgical and prolonged hormonal treatment of endometriosis; long-term dydrogesterone therapy for 12 months appears to be highly effective in the treatment of endometriosis-associated pain, infertility, and prevention of the recurrence of the disease. Dydrogesterone has a favorable safety profile and allows doctors to personalize the treatment of endometriosis depending on the current needs of patients.Bezhenar V.F., Kruglov S.Yu., Kuzmina N.S., Krylova Yu.S., Sergienko A.S., Abilbekova A.K., Zhemchuzhina T.Yu.
Keywords
external genital endometriosis
laparoscopic treatment of endometriosis
treatment of endometriosis with dydrogesterone
combined treatment of endometriosis
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Received 15.04.2021
Accepted 19.04.2021
About the Authors
Vitaly F. Bezhenar, Dr. Med. Sci., professor, Head of the Departments of Obstetrics, Gynecology and Neonatology/Obstetrics, Gynecology and Reproductology, I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia; Chief freelance specialist obstetrician-gynecologist of the Health Committee of the Government of St. Petersburg. Tel.: +7(812)338-78-66. E-mail: bez-vitaly@yandex.ru. ORCID: 0000-0002-7807-4929. 197022, Russia, St. Petersburg, L'va Tolstogo str., 6-8.Sergey Yu. Kruglov, PhD, Assistant of the Department of Obstetrics, Gynecology and Reproductology, I.P. Pavlov First Saint Petersburg State Medical University,
Ministry of Health of Russia. Tel.: +7(812)338-78-66. E-mail: skruglov89@mai.ru. ORCID: 0000-0002-7807-4929. 197022, Russia, St. Petersburg, L'va Tolstogo str., 6-8.
Natalya S. Kuzmina, PhD, Assistant of the Department of Obstetrics, Gynecology and Neonatology, Head of the Department of Oncology No. 7 (Oncogynecology)
of the Clinic of Obstetrics and Gynecology, I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia. Tel.: +7(812)338-78-66.
E-mail: dok.kuzmina@gmail.com. ORCID: 0000-0001-5759-4530. 197022, Russia, St. Petersburg, L'va Tolstogo str., 6-8.
Yulia S. Krylova, PhD, Assistant of the Department of Pathological Anatomy with the Pathological Department, I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia. Tel.: +7(812)338-70-43. ORCID: 0000-0002-8698-7904. 197022, Russia, St. Petersburg, L'va Tolstogo str., 6-8.
Alina S. Sergienko, postgraduate student of the Department of Obstetrics, Gynecology and Reproductology, I.P. Pavlov First Saint Petersburg State Medical University,
Ministry of Health of Russia. Tel.: +7(812)338-78-66. E-mail: md.sergienko@gmail.com. ORCID: 0000-0002-6362-107X. 197022, Russia, St. Petersburg, L'va Tolstogo str., 6-8.
Ainur K. Abilbekova, postgraduate student of the Department of Obstetrics, Gynecology and Reproductology, I.P. Pavlov First Saint Petersburg State Medical University,
Ministry of Health of Russia. Tel.: +7(812)338-78-66. E-mail: ainur.abilbekova@yahoo.com. ORCID: 0000-0003-3782-7135. 197022, Russia, St. Petersburg, L'va Tolstogo str., 6-8.
Tatyana Yu. Zhemchuzhina, PhD, Associate Professor of the Department of Obstetrics, Gynecology and Reproductology, I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia. Tel.: +7(812)338-78-66. E-mail: tzhemchuzhina@mail.ru. 197022, Russia, St. Petersburg, L'va Tolstogo str., 6-8.
For citation: Bezhenar V.F., Kruglov S.Yu., Kuzmina N.S., Krylova Yu.S., Sergienko A.S., Abilbekova A.K., Zhemchuzhina T.Yu. Effectiveness of long-term hormone therapy for endometriosis after surgical treatment.
Akusherstvo i Ginekologiya/ Obstetrics and gynecology. 2021; 4: 134-142 (in Russian)
https://dx.doi.org/10.18565/aig.2021.4.134-142
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