About
The Journal "Obstetrics and Gynecology"Journal HistoryAims and ScopePolicies on Conflict of Interest, Human and Animal Rights, and Informed ConsentEditorial ProcessData sharing statementAdvertising PolicyThe Process for Handling Cases Requiring Corrections, Retractions, and Editorial Expressions of ConcernEditorial BoardEditorial CounsilInformation for ProfessionalsNewsContacts
ArchiveEthical StandardsSubscription
For authors
InstructionsInformed consent policyContract offerEASE GuidelinesICJME CriteriaWAME Recommendations on ChatGPT and Chatbots in Relation to Scholarly Publications
Reviewing
About
The Journal "Obstetrics and Gynecology"Journal HistoryAims and ScopePolicies on Conflict of Interest, Human and Animal Rights, and Informed ConsentEditorial ProcessData sharing statementAdvertising PolicyThe Process for Handling Cases Requiring Corrections, Retractions, and Editorial Expressions of ConcernEditorial BoardEditorial CounsilInformation for ProfessionalsNewsContacts
ArchiveEthical StandardsSubscription
For authors
InstructionsInformed consent policyContract offerEASE GuidelinesICJME CriteriaWAME Recommendations on ChatGPT and Chatbots in Relation to Scholarly Publications
Reviewing
Logout
Obstetrics and Gynegology2023№11
Modern possibilities for optimizing the...

Modern possibilities for optimizing the diagnosis and therapy of ovarian endometriomas

DOI
https://dx.doi.org/10.18565/aig.2023.168

Chernukha G.E., Pronina V.A., Solopova A.E.

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, Moscow, Russia

Ovarian endometrioma (OMA) is one of the most common forms of endometriosis and its prevalence is estimated to reach 50%. At the same time, OMA is mostly combined with other forms of endometriosis, namely, deep and peritoneal endometriosis; therefore, despite the high sensitivity of ultrasound diagnosis, it is often necessary to use magnetic resonance imaging (MRI). The review article presents the data from the national and foreign literature illustrating the impact of both OMA and its surgical treatment on the ovarian reserve. The article focuses on modern ideas about the possibility of conservative management of such patients including the oncological risks for them. The importance of MRI is considered not only for determining the prevalence of endometriosis and differential diagnosis of endometriomas with ovarian cancer, but also as a method for evaluating the effectiveness of suppressive hormone therapy.
Conclusion: In spite of the negative impact of OMA on the level of anti-muller hormone, the surgical treatment should be reasonably justified, since performing surgery can lead to irreversible decrease in ovarian reserve and significant risk for postoperative relapse if there is no subsequent prescription of suppressive hormone therapy. Currently, there is no clear evidence base for the possibility of long-term hormonal therapy for OMA in women of reproductive age in terms of oncological risks. Therefore, it is recommended to perform MRI in this group of patients not only as a method of verification of endometriomas and differential diagnosis of endometrioid ovarian cancer, but also as a possibility of predicting the effect of suppressive hormone therapy, including the use of a measurable diffusion coefficient.

Authors’ contributions: Pronina V.A. – obtaining data for analysis; Pronina V.A., Chernukha G.E. – writing the text of the article; Solopova A.E., Chernukha G.E. – editing.
Conflicts of interest: The authors declare no conflicts of interest.
Funding: The study was conducted without sponsorship.
For citation: Chernukha G.E., Pronina V.A., Solopova A.E. Modern possibilities for  optimizing the diagnosis and therapy of ovarian endometriomas.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2023; (11): 28-35 (in Russian)
https://dx.doi.org/10.18565/aig.2023.168

Keywords

endometriosis
ovarian endometriomas
magnetic resonance imaging (MRI)
suppressive hormone therapy
Full text (in Russian)

References

  1. Blum S., Fasching P.A., Hildebrandt T., Lermann J., Heindl F., Born T. et al. Comprehensive characterization of endometriosis patients and disease patterns in a large clinical cohort. Arch. Gynecol. Obstet. 2022;305(4):977-84. https://dx.doi.org/10.1007/s00404-021-06200-w.
  2. von Theobald P., Cottenet J., Iacobelli S., Quantin C. Epidemiology of endometriosis in France: a large, nation-wide study based on hospital discharge data. Biomed. Res. Int. 2016;2016:3260952. https://dx.doi.org/10.1155/2016/3260952.
  3. Piriyev E., Schiermeier S., Römer T. Coexistence of endometriomas with extraovarian endometriosis and adhesions. Eur. J. Obst. Gynecol. Reprod. Biol. 2021;263:20-4. https://dx.doi.org/10.1016/j.ejogrb.2021.05.044.
  4. Chapron C., Santulli P., de Ziegler D., Noel J.C., Anaf V., Streuli I. et al. Ovarian endometrioma: severe pelvic pain is associated with deeply infiltrating endometriosis. Hum. Reprod. 2012;27(3):702-11. https://dx.doi.org/10.1093/humrep/der462.
  5. Perelló M., Martínez-Zamora M.A., Torres X., Munrós J., Llecha S., De Lazzari E. et al. Markers of deep infiltrating endometriosis in patients with ovarian endometrioma: a predictive model. Eur. J. Obstet. Gynecol. Reprod. Biol. 2017;209:55-60. https://dx.doi.org/10.1016/j.ejogrb.2015.11.024.
  6. Khan K.N., Kitajima M., Fujishita A., Hiraki K., Matsumoto A., Nakashima M., Masuzaki H. Pelvic pain in women with ovarian endometrioma is mostly associated with coexisting peritoneal lesions. Hum. Reprod. 2013;28(1):109-18. https://dx.doi.org/10.1093/humrep/des364.
  7. Alson S., Jokubkiene L., Henic E., Sladkevicius P. Prevalence of endometrioma and deep infiltrating endometriosis at transvaginal ultrasound examination of subfertile women undergoing assisted reproductive treatment. Fertil. Steril. 2022;118(5):915-23. https://dx.doi.org/10.1016/j.fertnstert.2022.07.024.
  8. ESHRE Endometriosis Guideline Group. ESHRE guideline: endometriosis. Human Reproduction Open. 2022; 2022(2): hoac009. https://dx.doi.org/10.1093/hropen/hoac009.
  9. Chapron C., Marcellin L., Borghese B., Santulli P. Rethinking mechanisms, diagnosis and management of endometriosis. Nat. Rev. Endocrinol. 2019;15(11):666-82. https://dx.doi.org/10.1038/s41574-019-0245-z.
  10. Maul L.V., Morrision J.E., Schollmeyer T., Alkatout I., Mettler L. Surgical therapy of ovarian endometrioma: recurrence and pregnancy rates. JSLS. 2014;18(3):e2014.00223. https://dx.doi.org/10.4293/JSLS.2014.00223.
  11. Seo J.W., Lee D.Y., Yoon B.K., Choi D. The age-related recurrence of endometrioma after conservative surgery. Eur. J. Obstet. Gynecol. Reprod. Biol. 2017;208:81-5. https://dx.doi.org/10.1016/j.ejogrb.2016.11.015.
  12. Nirgianakis K., Ma L., McKinnon B., Mueller M.D. Recurrence patterns after surgery in patients with different endometriosis subtypes: a long-term hospital-based cohort study. J. Clin. Med. 2020;9(2):496. https://dx.doi.org/10.3390/jcm9020496.
  13. Sibiude J., Santulli P., Marcellin L., Borghese B., Dousset B., Chapron C. Association of history of surgery for endometriosis with severity of deeply infiltrating endometriosis. Obstet. Gynecol. 2014;124(4):709-17. https://dx.doi.org/10.1097/AOG.0000000000000464.
  14. Xu B., Lin L., Pan Y., Chen P., Ye C., Zhao L. et al. The clinical picture and fecundity of primary and recurrent ovarian endometriosis with family history: a retrospective analysis. J. Clin. Med. 2023;12(5):1758. https://dx.doi.org/10.3390/jcm12051758.
  15. Benagiano G., Petraglia F., Gordts S., Brosens I. A new approach to the management of ovarian endometrioma to prevent tissue damage and recurrence. Reprod. Biomed. Online. 2016;32(6):556-62. https://dx.doi.org/10.1016/j.rbmo.2016.03.001.
  16. National Guideline Alliance (UK). Endometriosis: diagnosis and management. London: National Institute for Health and Care Excellence (NICE); 2017.
  17. Moreno-Sepulveda J., Romeral C., Niño G., Pérez-Benavente A. The effect of laparoscopic endometrioma surgery on Anti-Müllerian hormone: a systematic review of the literature and meta-analysis. JBRA Assist. Reprod. 2022;26(1):88-104. https://dx.doi.org/10.5935/1518-0557.20210060.
  18. Younis J.S., Shapso N., Ben-Sira Y., Nelson S.M., Izhaki I. Endometrioma surgery-a systematic review and meta-analysis of the effect on antral follicle count and anti-Müllerian hormone. Am. J. Obstet. Gynecol. 2022;226(1):33-51.e7. https://dx.doi.org/10.1016/j.ajog.2021.06.102.
  19. Muzii L., Achilli C., Lecce F., Bianchi A., Franceschetti S., Marchetti C. et al. Second surgery for recurrent endometriomas is more harmful to healthy ovarian tissue and ovarian reserve than first surgery. Fertil. Steril. 2015;103(3):738-43. https://dx.doi.org/10.1016/j.fertnstert.2014.12.101.
  20. Muzii L., Di Tucci C., Di Feliciantonio M., Galati G., Di Donato V., Musella A. et al. Antimüllerian hormone is reduced in the presence of ovarian endometriomas: a systematic review and meta-analysis. Fertil. Steril. 2018;110(5):932-940.e1. https://dx.doi.org/10.1016/j.fertnstert.2018.06.025.
  21. Benaglia L., Somigliana E., Vercellini P., Abbiati A., Ragni G., Fedele L. Endometriotic ovarian cysts negatively affect the rate of spontaneous ovulation. Hum. Reprod. 2009;24(9):2183-6. https://dx.doi.org/10.1093/humrep/dep202.
  22. Sanchez A.M., Viganò P., Somigliana E., Panina-Bordignon P., Vercellini P., Candiani M. The distinguishing cellular and molecular features of the endometriotic ovarian cyst: from pathophysiology to the potential endometrioma-mediated damage to the ovary. Hum. Reprod. Update. 2014;20(2):217-30. https://dx.doi.org/10.1093/humupd/dmt053.
  23. Leone Roberti Maggiore U., Scala C., Venturini P.L., Remorgida V., Ferrero S. Endometriotic ovarian cysts do not negatively affect the rate of spontaneous ovulation. Hum. Reprod. 2015;30(2):299-307. https://dx.doi.org/10.1093/humrep/deu308.
  24. Hernández A., Sanz A., Spagnolo E., Lopez A., Martínez J.P., Iniesta S. et al. Impact of ovarian endometrioma and surgery on reproductive outcomes: a single-center Spanish cohort study. Biomedicines. 2023;11(3):844. https://dx.doi.org/10.3390/biomedicines11030844.
  25. Kitajima M., Defrère S., Dolmans M.M., Colette S., Squifflet J., Van LangendoncktA., Donnez J. Endometriomas as a possible cause of reduced ovarian reserve in women with endometriosis. Fertil. Steril. 2011;96(3):685-91. https://dx.doi.org/10.1016/j.fertnstert.2011.06.064.
  26. Takeuchi A., Koga K., Satake E., Makabe T., Taguchi A., Miyashita M. et al. Endometriosis triggers excessive activation of primordial follicles via PI3K-PTEN-Akt-Foxo3 pathway. J. Clin. Endocrinol. Metab. 2019;104(11):5547-54. https://dx.doi.org/10.1210/jc.2019-00281.
  27. Younis J.S., Nelson S.M. What is the recommended management of a young woman with an intact endometrioma desiring future fertility? Front. Endocrinol. (Lausanne). 2022;13:1005597. https://dx.doi.org/10.3389/fendo.2022.1005597.
  28. Marcellin L., Santulli P., Bourdon M., Comte C., Maignien C., Just P.A. et al. Serum antimüllerian hormone concentration increases with ovarian endometrioma size. Fertil. Steril. 2019;111(5):944-952.e1. https://dx.doi.org/10.1016/j.fertnstert.2019.01.013.
  29. Qiu J.J., Liu Y.L., Liu M.H., Chen L.P., Xu D.W., Zhang Z.X. et al. Ovarian interstitial blood flow changes assessed by transvaginal colour Doppler sonography: predicting ovarian endometrioid cyst-induced injury to ovarian interstitial vessels. Arch. Gynecol. Obstet. 2012;285(2):427-33. https://dx.doi.org/10.1007/s00404-011-1971-1.
  30. Maneschi F., Marasá L., Incandela S., Mazzarese M., Zupi E. Ovarian cortex surrounding benign neoplasms: a histologic study. Am. J. Obstet. Gynecol. 1993;169(2 Pt 1):388-93. https://dx.doi.org/10.1016/0002-9378(93)90093-x.
  31. Bazot M., Lafont C., Rouzier R., Roseau G., Thomassin-Naggara I., Daraï E. Diagnostic accuracy of physical examination, transvaginal sonography, rectal endoscopic sonography, and magnetic resonance imaging to diagnose deep infiltrating endometriosis. Fertil. Steril. 2009;92(6):1825-33. https://dx.doi.org/10.1016/j.fertnstert.2008.09.005.
  32. Indrielle-Kelly T., Frühauf F., Fanta M., Burgetova A., Lavu D., Dundr P. et al. Diagnostic accuracy of ultrasound and MRI in the mapping of deep pelvic endometriosis using the International Deep Endometriosis Analysis (IDEA) Consensus. Biomed. Res. Int. 2020;2020:3583989. https://dx.doi.org/10.1155/2020/3583989.
  33. Nisenblat V., Bossuyt P.M., Farquhar C., Johnson N., Hull M.L. Imaging modalities for the non-invasive diagnosis of endometriosis. Cochrane Database Syst. Rev. 2016;2(2):CD009591. https://dx.doi.org/10.1002/14651858.CD009591.pub2.
  34. Holland T.K., Cutner A., Saridogan E., Mavrelos D., Pateman K., Jurkovic D. Ultrasound mapping of pelvic endometriosis: does the location and number of lesions affect the diagnostic accuracy? A multicentre diagnostic accuracy study. BMC Womens Health. 2013;13:43. https://dx.doi.org/10.1186/1472-6874-13-43.
  35. Bazot M., Bharwani N, Huchon C., Kinkel K., Cunha T.M., Guerra A. et al. European Society of Urogenital Radiology (ESUR) guidelines: MR imaging of pelvic endometriosis. Eur. Radiol. 2017;27(7):2765-75. https://dx.doi.org/10.1007/s00330-016-4673-z.
  36. Сыркашев Е.М., Солопова А.Е., Асатурова А.В. Сочетание серозной папиллярной цистаденофибромы яичника с распространенным наружным генитальным эндометриозом. Акушерство, гинекология и репродукция. 2020;14(6):694-703. [Syrkashev E.M., Solopova A.E., Asaturova A.V. Serous papillary cystadenofibroma combined with extended external genital endometriosis. Obstetrics, Gynecology and Reproduction. 2020;14(6):694-703. (in Russian)]. https://doi.org/10.17749/2313-7347/ob.gyn.rep.2020.190.
  37. Harada T., Taniguchi F., Kitajima M., Kitawaki J., Koga K., Momoeda M. et al. Clinical practice guidelines for endometriosis in Japan (the 3rd edition). J. Obstet. Gynaecol. Res. 2022;48(12):2993-3044. https://dx.doi.org/10.1111/jog.15416.
  38. Takeuchi M., Matsuzaki K., Nishitani H. Diffusion-weighted magnetic resonance imaging of ovarian tumors: differentiation of benign and malignant solid components of ovarian masses. J. Comput. Assist. Tomogr. 2010;34(2):173-6. https://dx.doi.org/10.1097/RCT.0b013e3181c2f0a2.
  39. Kim H.S., Kim T.H., Chung H.H., Song Y.S. Risk and prognosis of ovarian cancer in women with endometriosis: a meta-analysis. Br. J. Cancer. 2014;110(7):1878-90. https://dx.doi.org/10.1038/bjc.2014.29.
  40. Kvaskoff M., Mahamat-Saleh Y., Farland L.V., Shigesi N., Terry K.L., Harris H.R. et al. Endometriosis and cancer: a systematic review and meta-analysis. Hum. Reprod. Update. 2021;27(2):393-420. https://dx.doi.org/10.1093/humupd/dmaa045.
  41. Sarría-Santamera A., Khamitova Z., Gusmanov A., Terzic M., Polo-Santos M., Ortega M.A., Asúnsolo A. History of endometriosis is independently associated with an increased risk of ovarian Cancer. J. Pers. Med. 2022;12(8):1337. https://dx.doi.org/10.3390/jpm12081337.
  42. Honda M., Isono W., Tsuchiya A., Saito A., Tsuchiya H., Matsuyama R. et al. Significant risk factors for malignant transformation of ovarian endometrioma during dienogest treatment: a case report and retrospective study. J. Med. Case Rep. 2019;13(1):314. https://dx.doi.org/10.1186/s13256-019-2236-z.
  43. He Z.X., Shi H.H., Fan Q.B., Zhu L., Leng J.H., Sun D.W. et al. Predictive factors of ovarian carcinoma for women with ovarian endometrioma aged 45 years and older in China. J. Ovarian Res. 2017;10(1):45. https://dx.doi.org/10.1186/s13048-017-0343-2.
  44. Kobayashi H., Sumimoto K., Moniwa N., Imai M., Takakura K., Kuromaki T. et al. Risk of developing ovarian cancer among women with ovarian endometrioma: a cohort study in Shizuoka, Japan. Int. J. Gynecol. Cancer. 2007;17(1):37-43. https://dx.doi.org/10.1111/j.1525-1438.2006.00754.x.
  45. National Institutes of Health. National Cancer Institute, Surveillance, Epidemiology, and End Results Program Cancer Stat Facts: Female Breast Cancer. [accessed on 29 July 2022]; Available online: https://seer.cancer.gov/statfacts/html/ovary.html
  46. Олина А.А., Метелева Т.А. Опыт длительного применения диеногеста в терапии эндометриоза. Акушерство и гинекология. 2018; 7: 97-102. [Olina A.A. Meteleva T.A. Experience of prolonged use of dienogest in the treatment of endometriosis. Obstetrics and Gynecology. 2018; (7): 97-102. (in Russian)]. https://dx.doi.org/10.18565/aig.2018.7.97-102.
  47. Sugimoto K., Nagata C., Hayashi H., Yanagida S., Okamoto A. Use of dienogest over 53 weeks for the treatment of endometriosis. J. Obstet. Gynaecol. Res. 2015;41(12):1921-6. https://dx.doi.org/10.1111/jog.12811.
  48. Uludag S.Z., Demirtas E., Sahin Y., Aygen E.M. Dienogest reduces endometrioma volume and endometriosis-related pain symptoms. J. Obstet. Gynaecol. 2021;41(8):1246-51. https://dx.doi.org/10.1080/01443615.2020.1867962.
  49. Lee J.H., Song J.Y., Yi K.W., Lee S.R., Lee D.Y., Shin J.H. et al. Effectiveness of dienogest for treatment of recurrent endometriosis: multicenter data. Reprod. Sci. 2018;25(10):1515-22. https://dx.doi.org/10.1177/1933719118779733.
  50. Adachi K., Takahashi K., Nakamura K., Otake A., Sasamoto N., Miyoshi Y. et al. Postoperative administration of dienogest for suppressing recurrence of disease and relieving pain in subjects with ovarian endometriomas. Gynecol. Endocrinol. 2016;32(8):646-9. https://dx.doi.org/10.3109/09513590.2016.1147547.
  51. Ozaki R., Kumakiri J., Jinushi M., Ikuma S., Murakami K., Kawasaki Y., Kitade M. Comparison of effect of preoperative dienogest and gonadotropin-releasing hormone agonist administration on laparoscopic cystectomy for ovarian endometriomas. Arch. Gynecol. Obstet. 2020;302(4):969-76. https://dx.doi.org/10.1007/s00404-020-05691-3.
  52. Choi S.H., Kim S.E., Lim H.H., Lee D.Y., Choi D. Efficacy of post-operative medication to prevent recurrence of endometrioma: cyclic oral contraceptive (OC) after gonadotropin-releasing hormone (GnRH) agonist versus dienogest. J. Korean Med. Sci. 2022;37(26):e207. https://dx.doi.org/10.3346/jkms.2022.37.e207.
  53. Del Forno S., Mabrouk M., Arena A., Mattioli G., Giaquinto I., Paradisi R., Seracchioli R. Dienogest or norethindrone acetate for the treatment of ovarian endometriomas: can we avoid surgery? Eur. J. Obstet. Gynecol. Reprod. Biol. 2019;238:120-4. doi: 10.1016/j.ejogrb.2019.04.010.
  54. Angioni S., Pontis A., Malune M.E., Cela V., Luisi S., Litta P. et al. Is dienogest the best medical treatment for ovarian endometriomas? Results of a multicentric case control study. Gynecol. Endocrinol. 2020;36(1):84-6. https://dx.doi.org/10.1080/09513590.2019.1640674.
  55. Muzii L., Galati G., Di Tucci C., Di Feliciantonio M., Perniola G., Di Donato V. et al. Medical treatment of ovarian endometriomas: a prospective evaluation of the effect of dienogest on ovarian reserve, cyst diameter, and associated pain. Gynecol. Endocrinol. 2020;36(1):81-3. https://dx.doi.org/10.1080/09513590.2019.1640199.
  56. Crivellaro P.S., Rehman I., Chang S., Duigenan S., Holmes S., Hurrell C. et al. Current practice patterns, challenges, and need for education in performing and reporting advanced pelvic US and MRI to investigate endometriosis: a survey by the Canadian Association of Radiologists Endometriosis Working Group. Can. Assoc. Radiol. J. 2023:8465371231179292. https://dx.doi.org/10.1177/08465371231179292.
  57. Matsuura M., Tamate M., Tabuchi Y., Takada S., Tanaka R., Iwasaki M., Saito T. Prediction of the therapeutic effect of dienogest in ovarian endometrial cysts using the apparent diffusion coefficient. Gynecol. Endocrinol. 2014;30(8):597-9. https://dx.doi.org/10.3109/09513590.2014.911277.
  58. Sugimura K., Okizuka H., Kaji Y., Imaoka I., Shiotani S., Mukumoto H. et al. MRI in predicting the response of ovarian endometriomas to hormone therapy. J. Comput. Assist. Tomogr. 1996;20(1):145-50. https://dx.doi.org/10.1097/00004728-199601000-00026.
  59. Nagayasu M., Imanaka S., Kimura M., Maruyama S., Kawahara N. Effect of the cyst fluid concentration of iron on infertility in patients with ovarian endometrioma. World Acad. Sci. J. 2020;2:25. https://dx.doi.org/10.3892/wasj.2020.66.
  60. Yoshimoto C., Iwabuchi T., Shigetomi H., Kobayashi H. Cyst fluid iron-related compounds as useful markers to distinguish malignant transformation from benign endometriotic cysts. Cancer Biomark. 2015;15(4):493-9. https://dx.doi.org/10.3233/CBM-150484.
  61. Imanaka S., Maruyama S., Kimura M., Nagayasu M., Kawahara N., Kobayashi H. Relationship between cyst fluid concentrations of iron and severity of dysmenorrhea in patients with ovarian endometrioma. Gynecol. Obstet. Invest. 2021;86(1-2):185-92. https://dx.doi.org/10.1159/000514972.

Received 07.07.2023

Accepted 13.09.2023

About the Authors

Galina E. Chernukha, Dr. Med. Sci., Professor, Chief Researcher, obstetrician-gynecologist at the Department of Gynecological Endocrinology, Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, +7(985)999-60-00, c-galina1@yandex.ru,
https://orcid.org/0000-0002-9065-5689, 117997, Russia, Moscow, Ac. Oparin str., 4.
Veronika A. Pronina, obstetrician-gynecologist, PhD student, Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology,
Ministry of Health of Russia, +7(916)025-86-26, ver22595@yandex.ru, https://orcid.org/0000-0003-4566-4065, 117997, Russia, Moscow, Ac. Oparin str., 4.
Alina E. Solopova, Dr. Med. Sci., Associate Professor, Leading Researcher at the Department of Radiology, Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, +7(985)432-68-52, a_solopova@oparina4.ru, https://orcid.org/0000-0003-4768-115X,1
17997, Russia, Moscow, Ac. Oparin str., 4.
Corresponding author: Galina E. Chernukha, galina1@yandex.ru

Similar Articles

№10 / 2023
Rukhliada N.N.
The effectiveness of the administration regimen of Вuserelin-depo with a prolonged interval between injections: hormonal profile and acceptability of treatment for patients with endometriosis
№2 / 2023
Dubrovina S.O., Berlim Yu.D., Aleksandrina A.D., Vovkochina M.A., Bogunova D.Yu., Gimbut V.S., Bozhinskaya D.M.
Modern ideas about the diagnosis and treatment of endometriosis
№1 / 2024
Sulima A.N., Gudz O.V.
Retrospective analysis of urgent gynecological laparoscopic surgery in patients of reproductive age
№8 / 2024
Khashukoeva A.Z., Agaeva M.I., Savchenko T.N., Agaeva Z.A., Burdenko M.V., Lobacheva Yu.I.
The use of Buserelin-depo in the treatment ofcombined pathology of reproductive organs
№10 / 2024
Kondratovich L.M., Chursin V.V., Dzhabiev A.V., Chuprynin V.D., Badlaeva A.S.
Heterotopic pregnancy after surgical treatment of colorectal endometriosis
By continuing to use our site, you consent to the processing of cookies that ensure the proper functioning of the site.