Эндометриоз – хроническое воспалительное заболевание, склонное к частым рецидивам, которые могут быть объяснены с позиций как персистенции эндометриоидных гетеротопий, так и причин, приведших к возникновению эндометриоза. Хирургическое вмешательство обладает ограниченной эффективностью и не решает полностью задач, стоящих перед клиницистами: восстановление фертильности, купирование боли и предотвращение прогрессирования заболевания. Поэтому, хотя лапароскопия и остается ведущим методом диагностики и лечения эндометриоза, в настоящее время сформировалось мнение о необходимости долговременной медикаментозной терапии, направленной на улучшение качества жизни больных и восстановление/сохранение потенциала фертильности. Гормональная терапия включает в себя несколько групп лекарственных препаратов. Комбинированные оральные контрацептивы, не имея аннотированного показания для лечения эндометриоза, тем не менее широко применяются в международной клинической практике у сексуально активных женщин, которые страдают тазовой болью, ассоциированной с эндометриозом, и не планируют либо желают отсрочить деторождение.
Endometriosis is a chronic inflammatory disease. Its frequent elapses can be explained from the standpoint of both the persistence of endometrial heterotopias and the reasons leading to its emergence in the first place.
Surgical intervention has limited efficacy and thus cannot assist the clinicians in solving the occurring challenges such as fertility recovery, pain relief and disease progression prevention. Therefore, although laparoscopy still remains the main method of endometric diagnosis and treatment, specialists are now debating the need for long-term drug therapy that can improve the life quality of the patients and help in pregnancy preservation and recovery.
As for hormonal therapy, it includes several groups of drugs. Combined oral contraceptives are widely used in the world practice to ease the endometriosis associated pelvic pains in sexually active women wishing to delay child-bearing despite the lack of annotated indications for endometriosis treatment.
1. Prentice A. The ESHRE Guideline on Endometriosis 2008.
2. Леваков С.А., Хамошина М.Б. Эндометриоз: мировой прорыв в медикаментозном лечении. М.: Изд-во журнала Status Praesens, 2012.
3. Husby GK, Haugen RS, Moen MH. Diagnostic delay in women with pain and endometriosis. Acta Obstet Gynecol Scand 2003; 82 (7): 649–53.
4. Arruda MS, Petta CA, Abrão MS, Benetti-Pinto CL. Time elapsed from onset of symptoms to diagnosis of endometriosis in a cohort study of Brazilian women. Hum Reprod 2003; 18 (4): 756–9.
5. Hudelist G, Fritzer N, Thomas A et al. Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences. Hum Reprod 2012; 27 (12): 3412–6.
6. Адамян Л.В., Заратьянц О.В., Осипова А.А. и др. Роль пролиферации и апоптоза в патогенезе генитального эндометриоза. Проблемы репродукции. Спец. выпуск. 3-й Междунар. науч. конгресс «Новые технологии в акушерстве и гинекологии». 2007: 123–4.
7. Van Kaam KJAF, Romano A, Schouten JP et al. Progesterone receptor polymorphism +331G/A is associated with a decreased risk of deep infiltrating endometriosis. Hum Reprod 2007; 22 (1): 129–35.
8. Guidice LC, Kao LC. Endometriosis. Lancet 2004; 364: 1789–99.
9. Chapron C, Santulli P, Steuli I et al. Endometriosis: causes of pain. Int J Gynecol Obstet 2012; 119S3: S177.
10. Sinaii N, Plumb K, Cotton L et al. Differences in characteristics of 1000 women with endometriosis based on extent of disease. Fertil Steril 2008; 89: 538–45.
11. Vicino M, Scioscia M, Resta L et al. Fibrotic tissue in the endometrioma capsule: surgical and physiopathologic consideration from histologic findings. Fertil Steril 2009; 91: 1326–8.
12. Abrao MS. Surgical management of deep infiltrating endometriosis. Int J Gynecol Obstet 2012; 119S3: S161.
13. Garry R. The effectiveness of laparoscopic excision of endometriosis. Curr Opin Obstet Gynecol 2004; 16: 299–303.
14. Roberts CP, Rock JA. The current staging system for endometriosis: does it help? Obstet Gynecol Clin North Am 2003; 30: 115–32.
15. Matsuzaki S, Canis M, Pouly J-L et al. Both GnRH agonist and continuous oral progestin treatments reduce the expression of the tyrosine kinase receptor B and mu-opioid receptor in deep infiltrating endometriosis. Hum Reprod 2007; 22 (1): 124–8.
16. Schweppe K-W. Long-term use of progestogens – effects on endometriosis, adenomiosis and myomas. Gynecol Endocrinol 2007; 23 (S1): 17–21.
17. Petta CA, Ferriani RA, Abrao MS et al. Randomized clinical trial of a levonorgestrel-releasing intrauterine system and a depot GnRG analogue for the treatment of chronic pelvic pain in women with endometriosis. Hum Reprod 2005; 20: 1993–8.
18. Wong YK, Tang CH. Levonorgestrel-releasing intrauterine system (LNG-IUS, Mirena) vs depot medroxyprogesterone acetate (MPA, Depoprovera) as long-term maintenance therapy for patients with moderate and severe endometriosis: a randomized controlled trial. The 11th World Congress on controversies in obstetrics, gynecology and infertility. Paris 2008: 44A.
19. Momoeda M, Harada T, Terakawa N et al. Long-term use of dienogest for the treatment of endometriosis. J Obstet Gynaecol Res 2009; 35: 1069–76.
20. Prentice A, Deary AJ, Bland E. Progestagens and anti-progestagens for pain associated with endometriosis (Cochrane Review) 2003. In the Cochrane Library, Oxford. Issue 1. Oxford: Update Software.
21. Moore J, Kennedy S, Prentice A. Modern combined oral contraceptives for pain associated with endometriosis (Cochrane Review) 2003. In the Cochrane Library, Oxford. Issue 1. Oxford: Update Software.
22. Vercellini P, Pietropaolo G, Di Georgi O et al. Treatment of symptomatic rectovaginal endometriosis with an estrogen-progestogen combination versus low-dose norethindrone acetate. Fertil Steril 2005; 84: 1375–87.
23. Vercellini P, Somigliana E, Vigano P et al. Endometriosis: current and future medical therapies. Best Pract Res Clin Obstet Gynaecol 2008; 22: 275–306.
24. Fu L, Osuga Y, Hirata T et al. Dienogest inhibits BrdU uptake with G0/G1 arrest in cultured endometriotic stromal cells. Fertil Steril 2008; 89: 1344–7.
25. Horie S, Harada T, Mitsunari M et al. Progesterone and progestational compounds attenuate tumor necrosis factor alpha-induced interleukin-8 production via nuclear factor kappa B inactivation in endometriotic stromal cells. Fertil Steril 2005; 83: 1533–5.
26. Banno K, Kisu I, Yanokura M et al. Progestin therapy for endometrial cancer: the potential of fourth-generation progestin (review). Int J Oncol 2012; 40 (6): 1755–62.
27. Umene K, Banno K, Kisu I et al. New candidate therapeutic agents for endometrial cancer: potential for clinical practice (review). Oncol Reprod 2013, 29 (3): 855–60.
28. Yutaka S, Takashi T, Shizuka M et al. Dienogest, a synthetic progestin, inhibits the proliferation of immortalized human endometrial epithelial cells with suppression of cyclin D1 gene expression. Molec Hum Reprod 2009; 15 (10): 663–701.
29. 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 Gynecol Obstet 2010; 108: 21–5.
30. Кузнецова И.В., Коновалов В.А. Пролонгированные режимы приема комбинированных оральных контрацептивов в лечении генитального эндометриоза. Рус. мед. журн. 2009; 16: 1053–6.
31. Vercellini P, Barbara G, Somigliana E et al. Comparison of contraceptive ring and patch for the treatment of symptomatic endometriosis. Fertil Steril 2009; 15: 1077–88.
32. Галустян С.А., Белкина Н.В., Галустян В.С., Крутова В.А. Лечение наружного генитального эндометриоза препаратом «Жанин». Современные проблемы науки и образования. 2008; 11 (Прил. 1): 180–2.
________________________________________________
1. Prentice A. The ESHRE Guideline on Endometriosis 2008.
2. Леваков С.А., Хамошина М.Б. Эндометриоз: мировой прорыв в медикаментозном лечении. М.: Изд-во журнала Status Praesens, 2012.
3. Husby GK, Haugen RS, Moen MH. Diagnostic delay in women with pain and endometriosis. Acta Obstet Gynecol Scand 2003; 82 (7): 649–53.
4. Arruda MS, Petta CA, Abrão MS, Benetti-Pinto CL. Time elapsed from onset of symptoms to diagnosis of endometriosis in a cohort study of Brazilian women. Hum Reprod 2003; 18 (4): 756–9.
5. Hudelist G, Fritzer N, Thomas A et al. Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences. Hum Reprod 2012; 27 (12): 3412–6.
6. Адамян Л.В., Заратьянц О.В., Осипова А.А. и др. Роль пролиферации и апоптоза в патогенезе генитального эндометриоза. Проблемы репродукции. Спец. выпуск. 3-й Междунар. науч. конгресс «Новые технологии в акушерстве и гинекологии». 2007: 123–4.
7. Van Kaam KJAF, Romano A, Schouten JP et al. Progesterone receptor polymorphism +331G/A is associated with a decreased risk of deep infiltrating endometriosis. Hum Reprod 2007; 22 (1): 129–35.
8. Guidice LC, Kao LC. Endometriosis. Lancet 2004; 364: 1789–99.
9. Chapron C, Santulli P, Steuli I et al. Endometriosis: causes of pain. Int J Gynecol Obstet 2012; 119S3: S177.
10. Sinaii N, Plumb K, Cotton L et al. Differences in characteristics of 1000 women with endometriosis based on extent of disease. Fertil Steril 2008; 89: 538–45.
11. Vicino M, Scioscia M, Resta L et al. Fibrotic tissue in the endometrioma capsule: surgical and physiopathologic consideration from histologic findings. Fertil Steril 2009; 91: 1326–8.
12. Abrao MS. Surgical management of deep infiltrating endometriosis. Int J Gynecol Obstet 2012; 119S3: S161.
13. Garry R. The effectiveness of laparoscopic excision of endometriosis. Curr Opin Obstet Gynecol 2004; 16: 299–303.
14. Roberts CP, Rock JA. The current staging system for endometriosis: does it help? Obstet Gynecol Clin North Am 2003; 30: 115–32.
15. Matsuzaki S, Canis M, Pouly J-L et al. Both GnRH agonist and continuous oral progestin treatments reduce the expression of the tyrosine kinase receptor B and mu-opioid receptor in deep infiltrating endometriosis. Hum Reprod 2007; 22 (1): 124–8.
16. Schweppe K-W. Long-term use of progestogens – effects on endometriosis, adenomiosis and myomas. Gynecol Endocrinol 2007; 23 (S1): 17–21.
17. Petta CA, Ferriani RA, Abrao MS et al. Randomized clinical trial of a levonorgestrel-releasing intrauterine system and a depot GnRG analogue for the treatment of chronic pelvic pain in women with endometriosis. Hum Reprod 2005; 20: 1993–8.
18. Wong YK, Tang CH. Levonorgestrel-releasing intrauterine system (LNG-IUS, Mirena) vs depot medroxyprogesterone acetate (MPA, Depoprovera) as long-term maintenance therapy for patients with moderate and severe endometriosis: a randomized controlled trial. The 11th World Congress on controversies in obstetrics, gynecology and infertility. Paris 2008: 44A.
19. Momoeda M, Harada T, Terakawa N et al. Long-term use of dienogest for the treatment of endometriosis. J Obstet Gynaecol Res 2009; 35: 1069–76.
20. Prentice A, Deary AJ, Bland E. Progestagens and anti-progestagens for pain associated with endometriosis (Cochrane Review) 2003. In the Cochrane Library, Oxford. Issue 1. Oxford: Update Software.
21. Moore J, Kennedy S, Prentice A. Modern combined oral contraceptives for pain associated with endometriosis (Cochrane Review) 2003. In the Cochrane Library, Oxford. Issue 1. Oxford: Update Software.
22. Vercellini P, Pietropaolo G, Di Georgi O et al. Treatment of symptomatic rectovaginal endometriosis with an estrogen-progestogen combination versus low-dose norethindrone acetate. Fertil Steril 2005; 84: 1375–87.
23. Vercellini P, Somigliana E, Vigano P et al. Endometriosis: current and future medical therapies. Best Pract Res Clin Obstet Gynaecol 2008; 22: 275–306.
24. Fu L, Osuga Y, Hirata T et al. Dienogest inhibits BrdU uptake with G0/G1 arrest in cultured endometriotic stromal cells. Fertil Steril 2008; 89: 1344–7.
25. Horie S, Harada T, Mitsunari M et al. Progesterone and progestational compounds attenuate tumor necrosis factor alpha-induced interleukin-8 production via nuclear factor kappa B inactivation in endometriotic stromal cells. Fertil Steril 2005; 83: 1533–5.
26. Banno K, Kisu I, Yanokura M et al. Progestin therapy for endometrial cancer: the potential of fourth-generation progestin (review). Int J Oncol 2012; 40 (6): 1755–62.
27. Umene K, Banno K, Kisu I et al. New candidate therapeutic agents for endometrial cancer: potential for clinical practice (review). Oncol Reprod 2013, 29 (3): 855–60.
28. Yutaka S, Takashi T, Shizuka M et al. Dienogest, a synthetic progestin, inhibits the proliferation of immortalized human endometrial epithelial cells with suppression of cyclin D1 gene expression. Molec Hum Reprod 2009; 15 (10): 663–701.
29. 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 Gynecol Obstet 2010; 108: 21–5.
30. Кузнецова И.В., Коновалов В.А. Пролонгированные режимы приема комбинированных оральных контрацептивов в лечении генитального эндометриоза. Рус. мед. журн. 2009; 16: 1053–6.
31. Vercellini P, Barbara G, Somigliana E et al. Comparison of contraceptive ring and patch for the treatment of symptomatic endometriosis. Fertil Steril 2009; 15: 1077–88.
32. Галустян С.А., Белкина Н.В., Галустян В.С., Крутова В.А. Лечение наружного генитального эндометриоза препаратом «Жанин». Современные проблемы науки и образования. 2008; 11 (Прил. 1): 180–2.
Авторы
И.В.Кузнецова
ГБОУ ВПО Первый МГМУ им. И.М.Сеченова Минздрава России; ФГБОУ ВПО РУДН, Москва