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Эндометриоз: от трудностей диагностики к новым возможностям терапии
Эндометриоз: от трудностей диагностики к новым возможностям терапии
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Аннотация
В последние годы отмечается четкая тенденция к возрастанию частоты эндометриоза, который занимает одно из лидирующих мест в структуре гинекологических заболеваний и с которым сталкиваются врачи амбулаторной практики. Эндометриоз поражает женщин в лучшие годы их жизни! Нередко эндометриоз сочетается с другими гормонально обусловленными заболеваниями.
В статье освещена проблема сохранения репродуктивного здоровья женщин с эндометриозом, освещены факторы риска развития эндометриоза, основные принципы диагностики, а также принципы медикаментозной терапии эндометриоза.
Ключевые слова: эндометриоз, репродуктивное здоровье, медикаментозные методы лечения, диеногест.
Key words: endometriosis, reproductive health, medication methods of treatment of dienogest.
В статье освещена проблема сохранения репродуктивного здоровья женщин с эндометриозом, освещены факторы риска развития эндометриоза, основные принципы диагностики, а также принципы медикаментозной терапии эндометриоза.
Ключевые слова: эндометриоз, репродуктивное здоровье, медикаментозные методы лечения, диеногест.
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Key words: endometriosis, reproductive health, medication methods of treatment of dienogest.
Полный текст
Список литературы
1. Leyland N, Casper R, Laberge Ph et al. Endometriosis: Diagnosis and Management. Clinical Practice Guideline. JOGC 2010; 32 (7): 1–27.
2. Nnoaham KE, Hummelshoj L, Webster P et al. On behalf of the World Endometriosis Research Foundation Global Study of Women’s Health consortium, 2011. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertilityl Steril 2011; 96 (2): 366–73.
3. BSP Women’s Health Survey, 2009.
4. Марченко Л.А., Ильина Л.М. Современный взгляд на отдельные аспекты патогенеза эндометриоза (обзор литературы). Проблемы репродукции. 2011; 17 (1): 61–6.
5. Practice Committee of the American Society for Reproductive Medicine. Fertil Steril 2008; 90: 260–9.
6. J.A.Abbott, J.Hawe, R.D.Clayton, R.Garry. The effects and effectiveness of laparoscopic excision of endometriosis: a prospective study with 2–5 year follow-up. Hum Reprod 2003; 18: 1922–7; P.Vercellini, P.G.Crosignani, A.Abbiati et al. The effect of surgery for symptomatic endometriosis: the other side of the story. Hum Reprod 2009; 15: 177-88; K.Shakiba, J.F.Bena, K.M.McGill, J.Minger, T.Falcone. Surgical treatment of endometriosis: a 7-year follow-up on the requirement for further surgery. Obstet Gynecol 2008; 111: 1285–92
7. S.Kennedy, A.Bergqvist, C.Chapron et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 2005; 20: 2698–704
8. Sasagawa S, Shimizu Y, NagaokaT et al. Dienogest, a selective progestin, reduces plasma estradiol levels through induction of granulosa cells in the ovarian dominant follicle without follicle-stimulating hormone in monkeys. J Endocrin Invest 2008; 31: 636–41.
9. L.Fu, Y.Osuga, C.Morimoto et al. Dienogest inhibits BrdU uptake with G(0)/G(1) arrest in cultured endometriotic stromal cells. Fertil Steril 2008; 89: 1344–7
10. Y.Shimizu, S.Mita, T.Takeuchi et al. Dienogest, a synthetic progestin, inhibits prostaglandin E2 production and aromatase expression by human endometrial epithelial cells in a spheroid culture system. Steroids 2011; 76: 60–7
11. H.Katayama, T.Katayama, K.Uematsu et al. Effect of dienogest administration on angiogenesis and hemodynamics in a rat endometrial autograft model. Hum Reprod 2010; 25: 2851–8
12. Nakamura M, Katsuki Y, Shibutani Y, Oikawa T. Dienogest, a synthetic steroid, suppresses both embryonic and tumor-cell-induced angiogenesis. Eur J Pharmacol 1999; 386: 33–40.
13. Köhler G, Faustmann TA, Gerlinger C et al. A dose-ranging study to determine the efficacy and safety of 1, 2 and 4 mg of dienogest daily for endometriosis. Int J Gynaecol Obstet 2010; 108: 21–5.
14. Strowitzki T, Faustmann T, Gerlinger C, Seitz C. Dienogest in the treatment of endometriosis-associated pelvic pain: a 12-week, randomized, double-blind, placebo-controlled study. Eur J Obstet Gynecol Reprod Biol 2010; 151: 193–8.
15. Cosson M, Querleu D, Donnez J et al. Dienogest is as effective as triptorelin in the treatment of endometriosis after laparoscopic surgery: results of a prospective, multicenter, randomized study. Fertil Steril 2002; 77: 684–92.
16. Harada T, Momoeda M, Taketani Y et al. Dienogest is as effective as intranasal buserelin acetate for the relief of pain symptoms associated with endometriosis – a randomized, double-blind, multicenter, controlled trial. Fertil Steril 2009: 675–81.
17. Strowitzki T, Marr J, Gerlinger C et al. Dienogest is as effective as leuprolide acetate in treating the painful symptoms of endometriosis: a 24-week, randomized, multicentre, open-label trial. Hum Reprod 2010; 25: 633–41.
18. Foster RH, Wilde MI. Dienogest Drugs 1998; 56: 825–33.
19. Katsuki Y, Takano Y, Futamura Y et al. Effects of dienogest, a synthetic steroid, on experimental endometriosis in rats. Eur J Endocrinol 1998; 138: 216–26.
20. Klipping C, Duijkers I, Faustmann TA et al. Pharmacodynamic study of four oral dosages of dienogest. Fertil Steril 2010; 94 (Suppl.): S181. Fertil Steril 2010; 94: 181.
21. Moore C, Carol W, Gräser T et al. Influence of dienogest on ovulation in young fertile women. Clin Pharm 1999; 18: 271–8.
22. Rogers et al. Reprod Sci 2009; 16: 335–46. World Bank. Population Projection Tables by Country and Group, 2010.
23. Seitz C, Gerlinger C, Faustmann T, Strowitzki T. Safety of dienogest in the long-term treatment of endometriosis: a one-year, open-label follow-up study. Fertil Steril 2009; 92: S107.
24. Shimizu Y, Takeuchi T, Mita S et al. Dienogest, a synthetic progestin, inhibits the proliferation of immortalized human endometrial epithelial cells with suppression of cyclin D1 gene expression. Mol Hum Reprod 2009; 15: 693–701.
25. Vercellini P, Fedele L, Pietropaolo G et al. Progestogens for endometriosis: forward to the past. Hum Reprod Update 2003; 9: 387–96.
26. Прилепская В.Н. Клиническая гинекология, 2007, 2МЕДпресс-информ».
2. Nnoaham KE, Hummelshoj L, Webster P et al. On behalf of the World Endometriosis Research Foundation Global Study of Women’s Health consortium, 2011. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertilityl Steril 2011; 96 (2): 366–73.
3. BSP Women’s Health Survey, 2009.
4. Марченко Л.А., Ильина Л.М. Современный взгляд на отдельные аспекты патогенеза эндометриоза (обзор литературы). Проблемы репродукции. 2011; 17 (1): 61–6.
5. Practice Committee of the American Society for Reproductive Medicine. Fertil Steril 2008; 90: 260–9.
6. J.A.Abbott, J.Hawe, R.D.Clayton, R.Garry. The effects and effectiveness of laparoscopic excision of endometriosis: a prospective study with 2–5 year follow-up. Hum Reprod 2003; 18: 1922–7; P.Vercellini, P.G.Crosignani, A.Abbiati et al. The effect of surgery for symptomatic endometriosis: the other side of the story. Hum Reprod 2009; 15: 177-88; K.Shakiba, J.F.Bena, K.M.McGill, J.Minger, T.Falcone. Surgical treatment of endometriosis: a 7-year follow-up on the requirement for further surgery. Obstet Gynecol 2008; 111: 1285–92
7. S.Kennedy, A.Bergqvist, C.Chapron et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 2005; 20: 2698–704
8. Sasagawa S, Shimizu Y, NagaokaT et al. Dienogest, a selective progestin, reduces plasma estradiol levels through induction of granulosa cells in the ovarian dominant follicle without follicle-stimulating hormone in monkeys. J Endocrin Invest 2008; 31: 636–41.
9. L.Fu, Y.Osuga, C.Morimoto et al. Dienogest inhibits BrdU uptake with G(0)/G(1) arrest in cultured endometriotic stromal cells. Fertil Steril 2008; 89: 1344–7
10. Y.Shimizu, S.Mita, T.Takeuchi et al. Dienogest, a synthetic progestin, inhibits prostaglandin E2 production and aromatase expression by human endometrial epithelial cells in a spheroid culture system. Steroids 2011; 76: 60–7
11. H.Katayama, T.Katayama, K.Uematsu et al. Effect of dienogest administration on angiogenesis and hemodynamics in a rat endometrial autograft model. Hum Reprod 2010; 25: 2851–8
12. Nakamura M, Katsuki Y, Shibutani Y, Oikawa T. Dienogest, a synthetic steroid, suppresses both embryonic and tumor-cell-induced angiogenesis. Eur J Pharmacol 1999; 386: 33–40.
13. Köhler G, Faustmann TA, Gerlinger C et al. A dose-ranging study to determine the efficacy and safety of 1, 2 and 4 mg of dienogest daily for endometriosis. Int J Gynaecol Obstet 2010; 108: 21–5.
14. Strowitzki T, Faustmann T, Gerlinger C, Seitz C. Dienogest in the treatment of endometriosis-associated pelvic pain: a 12-week, randomized, double-blind, placebo-controlled study. Eur J Obstet Gynecol Reprod Biol 2010; 151: 193–8.
15. Cosson M, Querleu D, Donnez J et al. Dienogest is as effective as triptorelin in the treatment of endometriosis after laparoscopic surgery: results of a prospective, multicenter, randomized study. Fertil Steril 2002; 77: 684–92.
16. Harada T, Momoeda M, Taketani Y et al. Dienogest is as effective as intranasal buserelin acetate for the relief of pain symptoms associated with endometriosis – a randomized, double-blind, multicenter, controlled trial. Fertil Steril 2009: 675–81.
17. Strowitzki T, Marr J, Gerlinger C et al. Dienogest is as effective as leuprolide acetate in treating the painful symptoms of endometriosis: a 24-week, randomized, multicentre, open-label trial. Hum Reprod 2010; 25: 633–41.
18. Foster RH, Wilde MI. Dienogest Drugs 1998; 56: 825–33.
19. Katsuki Y, Takano Y, Futamura Y et al. Effects of dienogest, a synthetic steroid, on experimental endometriosis in rats. Eur J Endocrinol 1998; 138: 216–26.
20. Klipping C, Duijkers I, Faustmann TA et al. Pharmacodynamic study of four oral dosages of dienogest. Fertil Steril 2010; 94 (Suppl.): S181. Fertil Steril 2010; 94: 181.
21. Moore C, Carol W, Gräser T et al. Influence of dienogest on ovulation in young fertile women. Clin Pharm 1999; 18: 271–8.
22. Rogers et al. Reprod Sci 2009; 16: 335–46. World Bank. Population Projection Tables by Country and Group, 2010.
23. Seitz C, Gerlinger C, Faustmann T, Strowitzki T. Safety of dienogest in the long-term treatment of endometriosis: a one-year, open-label follow-up study. Fertil Steril 2009; 92: S107.
24. Shimizu Y, Takeuchi T, Mita S et al. Dienogest, a synthetic progestin, inhibits the proliferation of immortalized human endometrial epithelial cells with suppression of cyclin D1 gene expression. Mol Hum Reprod 2009; 15: 693–701.
25. Vercellini P, Fedele L, Pietropaolo G et al. Progestogens for endometriosis: forward to the past. Hum Reprod Update 2003; 9: 387–96.
26. Прилепская В.Н. Клиническая гинекология, 2007, 2МЕДпресс-информ».
2. Nnoaham KE, Hummelshoj L, Webster P et al. On behalf of the World Endometriosis Research Foundation Global Study of Women’s Health consortium, 2011. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertilityl Steril 2011; 96 (2): 366–73.
3. BSP Women’s Health Survey, 2009.
4. Марченко Л.А., Ильина Л.М. Современный взгляд на отдельные аспекты патогенеза эндометриоза (обзор литературы). Проблемы репродукции. 2011; 17 (1): 61–6.
5. Practice Committee of the American Society for Reproductive Medicine. Fertil Steril 2008; 90: 260–9.
6. J.A.Abbott, J.Hawe, R.D.Clayton, R.Garry. The effects and effectiveness of laparoscopic excision of endometriosis: a prospective study with 2–5 year follow-up. Hum Reprod 2003; 18: 1922–7; P.Vercellini, P.G.Crosignani, A.Abbiati et al. The effect of surgery for symptomatic endometriosis: the other side of the story. Hum Reprod 2009; 15: 177-88; K.Shakiba, J.F.Bena, K.M.McGill, J.Minger, T.Falcone. Surgical treatment of endometriosis: a 7-year follow-up on the requirement for further surgery. Obstet Gynecol 2008; 111: 1285–92
7. S.Kennedy, A.Bergqvist, C.Chapron et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 2005; 20: 2698–704
8. Sasagawa S, Shimizu Y, NagaokaT et al. Dienogest, a selective progestin, reduces plasma estradiol levels through induction of granulosa cells in the ovarian dominant follicle without follicle-stimulating hormone in monkeys. J Endocrin Invest 2008; 31: 636–41.
9. L.Fu, Y.Osuga, C.Morimoto et al. Dienogest inhibits BrdU uptake with G(0)/G(1) arrest in cultured endometriotic stromal cells. Fertil Steril 2008; 89: 1344–7
10. Y.Shimizu, S.Mita, T.Takeuchi et al. Dienogest, a synthetic progestin, inhibits prostaglandin E2 production and aromatase expression by human endometrial epithelial cells in a spheroid culture system. Steroids 2011; 76: 60–7
11. H.Katayama, T.Katayama, K.Uematsu et al. Effect of dienogest administration on angiogenesis and hemodynamics in a rat endometrial autograft model. Hum Reprod 2010; 25: 2851–8
12. Nakamura M, Katsuki Y, Shibutani Y, Oikawa T. Dienogest, a synthetic steroid, suppresses both embryonic and tumor-cell-induced angiogenesis. Eur J Pharmacol 1999; 386: 33–40.
13. Köhler G, Faustmann TA, Gerlinger C et al. A dose-ranging study to determine the efficacy and safety of 1, 2 and 4 mg of dienogest daily for endometriosis. Int J Gynaecol Obstet 2010; 108: 21–5.
14. Strowitzki T, Faustmann T, Gerlinger C, Seitz C. Dienogest in the treatment of endometriosis-associated pelvic pain: a 12-week, randomized, double-blind, placebo-controlled study. Eur J Obstet Gynecol Reprod Biol 2010; 151: 193–8.
15. Cosson M, Querleu D, Donnez J et al. Dienogest is as effective as triptorelin in the treatment of endometriosis after laparoscopic surgery: results of a prospective, multicenter, randomized study. Fertil Steril 2002; 77: 684–92.
16. Harada T, Momoeda M, Taketani Y et al. Dienogest is as effective as intranasal buserelin acetate for the relief of pain symptoms associated with endometriosis – a randomized, double-blind, multicenter, controlled trial. Fertil Steril 2009: 675–81.
17. Strowitzki T, Marr J, Gerlinger C et al. Dienogest is as effective as leuprolide acetate in treating the painful symptoms of endometriosis: a 24-week, randomized, multicentre, open-label trial. Hum Reprod 2010; 25: 633–41.
18. Foster RH, Wilde MI. Dienogest Drugs 1998; 56: 825–33.
19. Katsuki Y, Takano Y, Futamura Y et al. Effects of dienogest, a synthetic steroid, on experimental endometriosis in rats. Eur J Endocrinol 1998; 138: 216–26.
20. Klipping C, Duijkers I, Faustmann TA et al. Pharmacodynamic study of four oral dosages of dienogest. Fertil Steril 2010; 94 (Suppl.): S181. Fertil Steril 2010; 94: 181.
21. Moore C, Carol W, Gräser T et al. Influence of dienogest on ovulation in young fertile women. Clin Pharm 1999; 18: 271–8.
22. Rogers et al. Reprod Sci 2009; 16: 335–46. World Bank. Population Projection Tables by Country and Group, 2010.
23. Seitz C, Gerlinger C, Faustmann T, Strowitzki T. Safety of dienogest in the long-term treatment of endometriosis: a one-year, open-label follow-up study. Fertil Steril 2009; 92: S107.
24. Shimizu Y, Takeuchi T, Mita S et al. Dienogest, a synthetic progestin, inhibits the proliferation of immortalized human endometrial epithelial cells with suppression of cyclin D1 gene expression. Mol Hum Reprod 2009; 15: 693–701.
25. Vercellini P, Fedele L, Pietropaolo G et al. Progestogens for endometriosis: forward to the past. Hum Reprod Update 2003; 9: 387–96.
26. Прилепская В.Н. Клиническая гинекология, 2007, 2МЕДпресс-информ».
________________________________________________
2. Nnoaham KE, Hummelshoj L, Webster P et al. On behalf of the World Endometriosis Research Foundation Global Study of Women’s Health consortium, 2011. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertilityl Steril 2011; 96 (2): 366–73.
3. BSP Women’s Health Survey, 2009.
4. Марченко Л.А., Ильина Л.М. Современный взгляд на отдельные аспекты патогенеза эндометриоза (обзор литературы). Проблемы репродукции. 2011; 17 (1): 61–6.
5. Practice Committee of the American Society for Reproductive Medicine. Fertil Steril 2008; 90: 260–9.
6. J.A.Abbott, J.Hawe, R.D.Clayton, R.Garry. The effects and effectiveness of laparoscopic excision of endometriosis: a prospective study with 2–5 year follow-up. Hum Reprod 2003; 18: 1922–7; P.Vercellini, P.G.Crosignani, A.Abbiati et al. The effect of surgery for symptomatic endometriosis: the other side of the story. Hum Reprod 2009; 15: 177-88; K.Shakiba, J.F.Bena, K.M.McGill, J.Minger, T.Falcone. Surgical treatment of endometriosis: a 7-year follow-up on the requirement for further surgery. Obstet Gynecol 2008; 111: 1285–92
7. S.Kennedy, A.Bergqvist, C.Chapron et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 2005; 20: 2698–704
8. Sasagawa S, Shimizu Y, NagaokaT et al. Dienogest, a selective progestin, reduces plasma estradiol levels through induction of granulosa cells in the ovarian dominant follicle without follicle-stimulating hormone in monkeys. J Endocrin Invest 2008; 31: 636–41.
9. L.Fu, Y.Osuga, C.Morimoto et al. Dienogest inhibits BrdU uptake with G(0)/G(1) arrest in cultured endometriotic stromal cells. Fertil Steril 2008; 89: 1344–7
10. Y.Shimizu, S.Mita, T.Takeuchi et al. Dienogest, a synthetic progestin, inhibits prostaglandin E2 production and aromatase expression by human endometrial epithelial cells in a spheroid culture system. Steroids 2011; 76: 60–7
11. H.Katayama, T.Katayama, K.Uematsu et al. Effect of dienogest administration on angiogenesis and hemodynamics in a rat endometrial autograft model. Hum Reprod 2010; 25: 2851–8
12. Nakamura M, Katsuki Y, Shibutani Y, Oikawa T. Dienogest, a synthetic steroid, suppresses both embryonic and tumor-cell-induced angiogenesis. Eur J Pharmacol 1999; 386: 33–40.
13. Köhler G, Faustmann TA, Gerlinger C et al. A dose-ranging study to determine the efficacy and safety of 1, 2 and 4 mg of dienogest daily for endometriosis. Int J Gynaecol Obstet 2010; 108: 21–5.
14. Strowitzki T, Faustmann T, Gerlinger C, Seitz C. Dienogest in the treatment of endometriosis-associated pelvic pain: a 12-week, randomized, double-blind, placebo-controlled study. Eur J Obstet Gynecol Reprod Biol 2010; 151: 193–8.
15. Cosson M, Querleu D, Donnez J et al. Dienogest is as effective as triptorelin in the treatment of endometriosis after laparoscopic surgery: results of a prospective, multicenter, randomized study. Fertil Steril 2002; 77: 684–92.
16. Harada T, Momoeda M, Taketani Y et al. Dienogest is as effective as intranasal buserelin acetate for the relief of pain symptoms associated with endometriosis – a randomized, double-blind, multicenter, controlled trial. Fertil Steril 2009: 675–81.
17. Strowitzki T, Marr J, Gerlinger C et al. Dienogest is as effective as leuprolide acetate in treating the painful symptoms of endometriosis: a 24-week, randomized, multicentre, open-label trial. Hum Reprod 2010; 25: 633–41.
18. Foster RH, Wilde MI. Dienogest Drugs 1998; 56: 825–33.
19. Katsuki Y, Takano Y, Futamura Y et al. Effects of dienogest, a synthetic steroid, on experimental endometriosis in rats. Eur J Endocrinol 1998; 138: 216–26.
20. Klipping C, Duijkers I, Faustmann TA et al. Pharmacodynamic study of four oral dosages of dienogest. Fertil Steril 2010; 94 (Suppl.): S181. Fertil Steril 2010; 94: 181.
21. Moore C, Carol W, Gräser T et al. Influence of dienogest on ovulation in young fertile women. Clin Pharm 1999; 18: 271–8.
22. Rogers et al. Reprod Sci 2009; 16: 335–46. World Bank. Population Projection Tables by Country and Group, 2010.
23. Seitz C, Gerlinger C, Faustmann T, Strowitzki T. Safety of dienogest in the long-term treatment of endometriosis: a one-year, open-label follow-up study. Fertil Steril 2009; 92: S107.
24. Shimizu Y, Takeuchi T, Mita S et al. Dienogest, a synthetic progestin, inhibits the proliferation of immortalized human endometrial epithelial cells with suppression of cyclin D1 gene expression. Mol Hum Reprod 2009; 15: 693–701.
25. Vercellini P, Fedele L, Pietropaolo G et al. Progestogens for endometriosis: forward to the past. Hum Reprod Update 2003; 9: 387–96.
26. Прилепская В.Н. Клиническая гинекология, 2007, 2МЕДпресс-информ».
Авторы
В.Н.Прилепская, Е.В.Иванова, А.В.Тагиева, А.Б.Летуновская
ФГБУ Научный центр акушерства, гинекологии и перинатологии им. акад. В.И.Кулакова Минздрава РФ, Москва
ФГБУ Научный центр акушерства, гинекологии и перинатологии им. акад. В.И.Кулакова Минздрава РФ, Москва
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