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Obstetrics and Gynegology2022№1
Modern principles of medical treatment...

Modern principles of medical treatment for endometriosis at an early reproductive age

DOI
https://dx.doi.org/10.18565/aig.2022.01.31-41

Khashchenko E.P., Sivirinova A.S., Uvarova E.V.

1) Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation, Moscow, Russian Federation 2) M.V. Lomonosov Moscow State University, Moscow, Russian Federation 3) I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation
It is generally accepted that the priority in the choice of treatment belongs to drug therapy, since an adequately and timely selected regimen can prevent the need for surgery. To date, there is no universal approach to medical treatment for endometriosis. However, given that drugs control, but do not cure the disease, long-term pharmacological treatment may be required until pregnancy or, sometimes, physiological menopause occurs. This review presents the current state of the problem of medical treatment for endometriosis and the available clinical guidelines on this topic, including in the treatment of early reproductive-aged patients. It summarizes currently available information on approaches to treating endometriosis. The review discusses the drug groups that show the highest efficacy in treating endometriosis and dysmenorrhea associated with endometriosis (gestagens, combined oral contraceptives, gonadotropin-releasing hormone agonists), as well as the promising drugs that go through clinical trials (selective progesterone and estrogen receptor modulators, metformin, statins, cabergoline, etc.). Particular attention is paid to the mechanisms of anti-endometrioid action of gestagens, which is associated not only with the induction of endometrial decidualization, but also with anti-inflammatory and immunomodulatory effects, the decrease in the transcription of neuro- and angiogenic factors, and the suppression of the proliferative activity of foci and trophism to the latter, by inhibiting the growth of blood vessels and nerves.
Conclusion: The available treatment regimens for endometriosis combine symptomatic and pathogenic effects that determine the long-term efficacy, safety profile, and rationale, starting from the diagnosis at an early reproductive age.

Keywords

endometriosis
adolescent females
hormonal therapy
gestagens
dienogest
dydrogesterone
combined oral contraceptives
medical rehabilitation
Full text (in Russian)

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Received 02.12.2021

Accepted 12.01.2022 

About the Authors

Elena P. Khashchenko, PhD, Senior Researcher of 2nd Gynecological (child and adolescent) Department, Academician V.I. Kulakov National edical Research Genter for Obstetrics, Gynecology and Perinatology, Ministry of Healthcare of the Russian Federation, khashchenko_elena@mail.ru, https://orcid.org/0000-0002-3195-307X, 117997, Russia, Moscow, Ac. Oparina str., 4.
Anastasia S. Sivirinova, student, Faculty of Fundamental Medicine, MV. Lomonosov Moscow State University, sivirinovaa@gmail.com, https://orcid.org/0000-0002-1334-2638, 119991, Russia, Moscow, Leninskye Gory, 1.
Elena V. Uvarova, Dr. Med. Sci., Professor, Corresponding Member of the RAS, Head of 2nd Gynecological (child and adolescent) Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Healthcare of the Russian Federation, elena-uvarova@yandex.ru, https://orcid.org/0000-0002-3105-5640, 117997, Russia, Moscow, Ac. Oparina str., 4.

Authors' contributions: Khashchenko E.P., Sivirinova A.S. (the authors’ equal contribution) - concept of the investigation, search for literature sources, writing and editing the text; Uvarova E.V. - final editing of the text.
Conflicts of interest: The authors declare that there are no conflicts of interest.
Funding: The investigation has been sponsored by the Russian Foundation for Basic Research, Project No. 19-013-00397 “Affective states in adolescent and early reproductive-aged female patients with chronic pelvic pain in the presence of gynecological diseases”, the Ministry of Health state assignment 18-A21 “The role of energy metabolism and immune defense disorders in the development of various types of endometriosis and in that of personalized therapy and prognosis of its efficiency in the early reproductive period (from menarche to age 18 years)”.
For citation: Khashchenko E.P., Sivirinova A.S., Uvarova E.V. Modern principles of medical treatmentfor endometriosis at an early reproductive age.
Akusherstvo i Ginekologiya/ Obstetrics and Gynecology. 2022; 1: (in Russian)
https://dx.doi.org/10.18565/aig.2022.1.

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