Эндометриоз поражает около 10% женщин репродуктивного возраста и может оказывать негативное влияние на качество жизни (КЖ). В связи с гетерогенностью симптомов, вплоть до отсутствия клинических проявлений, постановка диагноза на ранних стадиях затруднена. По данной причине возникает необходимость комплексно оценивать жалобы пациентки, включая тщательный сбор соматического анамнеза, результаты методов лучевой диагностики в сочетании с факторами риска развития эндометриоза. При ранней постановке диагноза предоставляется возможность досрочно начать лечение, что позволит, вероятно, избежать оперативного вмешательства. В статье представлены данные о ведении пациенток с эндометриозом в амбулаторных условиях, описаны методы неинвазивной визуальной диагностики эндометриоза. Рассмотрены современные варианты фармакотерапии, направленные на контроль развития заболевания и на улучшение КЖ пациенток в долгосрочной перспективе. Своевременно начатое медикаментозное лечение благоприятно влияет на КЖ больных, в ряде случаев приводит к регрессу объемных образований и улучшает прогноз для реализации репродуктивной функции. Трансформация фокуса на клинической диагностике в сочетании с неинвазивной визуализацией сокращает время между первой консультацией и окончательным диагнозом. Согласно современной позиции российских и международных обществ терапия должна быть длительной, соответственно, возникает необходимость в подборе лечения с возможностью предикции ответа и контроля за течением заболевания.
Ключевые слова: эндометриоз, прогестагены, консервативная терапия, магнитно-резонансная терапия, ультразвуковое исследование
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Endometriosis affects about 10% of women of reproductive age and can negatively impact their quality of life (QoL). Due to the heterogeneity of symptoms or even their absence, early diagnosis is difficult. Therefore, it is necessary to comprehensively assess the patient's complaints, including a thorough review of medical history, the results of imaging studies, and risk factors for endometriosis. Early diagnosis enables preemptive treatment and avoids surgical intervention. The article presents data on managing patients with endometriosis in outpatient settings, describing methods for non-invasive imaging diagnosis of endometriosis. Current options of pharmacotherapy aimed at controlling the development of the disease and improving the QoL of patients in the long term are addressed. Timely initiated drug treatment improves the QoL of patients, in some cases, leads to a regression of the lesions, and improves the prognosis for the reproductive function. A shift in focus to clinical diagnosis, combined with non-invasive imaging, shortens the time between the first consultation and the final diagnosis. According to the current view of Russian and international professional societies, therapy should be long-term; therefore, selecting treatment with predictable responses and monitoring the course of the disease is necessary.
Keywords: endometriosis, progestogens, non-surgical therapy, magnetic resonance therapy, ultrasound examination
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1. Wang Y, Nicholes K, Shih IM. The Origin and Pathogenesis of Endometriosis. Annu Rev Pathol. 2020;15:71-95. DOI:10.1146/annurev-pathmechdis-012419-032654
2. Ahn SH, Monsanto SP, Miller C, et al. Pathophysiology and Immune Dysfunction in Endometriosis. Biomed Res Int. 2015;2015:795976. DOI:10.1155/2015/795976
3. Symons LK, Miller JE, Kay VR, et al. The Immunopathophysiology of Endometriosis. Trends Mol Med. 2018;24(9):748-62. DOI:10.1016/j.molmed.2018.07.004
4. Aznaurova YaB, Petrov IA, Suntsova MV, et al. Interconnection between gene expression and signaling pathways activation profiles in eutopic and ectopic endometrium of patients with external genital endometriosis. Russian Journal of Human Reproduction. 2018;24(4):13-21 (in Russian). DOI:10.17116/repro20182404113
5. Rush G, Misajon R. Examining subjective wellbeing and health-related quality of life in women with endometriosis. Health Care Women Int. 2018;39(3):303-21. DOI:10.1080/07399332.2017.1397671
6. Subedi SS, Bhansakarya R, Shrestha P, Sharma SK. Outcome of Laparoscopy in Infertile Couples attending a Teaching Hospital in Eastern Nepal: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc. 2020;58(231):889-92. DOI:10.31729/jnma.5542
7. Nnoaham KE, Hummelshoj L, Webster P, et al. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril.
2011;96(2):366-73.e8. DOI:10.1016/j.fertnstert.2011.05.090
8. Martire FG, Russo C, Selntigia A, et al. Early noninvasive diagnosis of endometriosis: dysmenorrhea and specific ultrasound findings are important indicators in young women. Fertil Steril. 2023;119(3):455-64. DOI:10.1016/j.fertnstert.2022.12.004
9. Becker CM, Bokor A, Heikinheimo O, et al. ESHRE guideline: endometriosis. Hum Reprod Open. 2022;2022(2):hoac009. DOI:10.1093/hropen/hoac009
10. Avila I, Filogônio ID, Costa LM, Carneiro MM. Anatomical distribution of deep infiltrating endometriosis and its relationship to pelvic pain. J Gynecol Surg. 2016;32:99-103. DOI:10.1089/gyn.2015.0092
11. Dai Y, Leng JH, Lang JH, et al. Anatomical distribution of pelvic deep infiltrating endometriosis and its relationship with pain symptoms. Chin Med J (Engl). 2012;125(2):209-13.
12. Green IC, Burnett T, Famuyide A. Persistent Pelvic Pain in Patients With Endometriosis. Clin Obstet Gynecol. 2022;65(4):775-85. DOI:10.1097/GRF.0000000000000712
13. Signorile PG, Cassano M, Viceconte R, et al. Endometriosis: A Retrospective Analysis of Clinical Data from a Cohort of 4,083 Patients, With Focus on Symptoms. In Vivo. 2022;36(2):874-83. DOI:10.21873/invivo.12776
14. Evans SF, Brooks TA, Esterman AJ, et al. The comorbidities of dysmenorrhea: a clinical survey comparing symptom profile in women with and without endometriosis. J Pain Res. 2018;11:3181-94. DOI:10.2147/JPR.S179409
15. Fauconnier A, Staraci S, Huchon C, et al. Comparison of patient- and physician-based descriptions of symptoms of endometriosis: a qualitative study. Hum Reprod. 2013;28(10):2686-94. DOI:10.1093/humrep/det310
16. Bontempo AC, Mikesell L. Patient perceptions of misdiagnosis of endometriosis: results from an online national survey. Diagnosis (Berl). 2020;7(2):97-106.
DOI:10.1515/dx-2019-0020
17. Chapron C, Lang JH, Leng JH, et al. Factors and Regional Differences Associated with Endometriosis: A Multi-Country, Case-Control Study. Adv Ther. 2016;33(8):1385-407. DOI:10.1007/s12325-016-0366-x
18. Ballard KD, Seaman HE, de Vries CS, Wright JT. Can symptomatology help in the diagnosis of endometriosis? Findings from a national case-control study – Part 1. BJOG. 2008;115(11):1382-91. DOI:10.1111/j.1471-0528.2008.01878.x
19. Novellas S, Chassang M, Bouaziz J, et al. Anterior pelvic endometriosis: MRI features. Abdom Imaging. 2010;35(6):742-9. DOI:10.1007/s00261-010-9600-1
20. Saha R, Pettersson HJ, Svedberg P, et al. Heritability of endometriosis. Fertil Steril. 2015;104(4):947-52. DOI:10.1016/j.fertnstert.2015.06.035
21. Allaire C, Bedaiwy MA, Yong PJ. Diagnostic et gestion thérapeutique de l’endométriose. CMAJ. 2023;195(24):E853-62. DOI:10.1503/cmaj.220637-f
22. Riazi H, Tehranian N, Ziaei S, et al. Clinical diagnosis of pelvic endometriosis: a scoping review. BMC Womens Health. 2015;15:39. DOI:10.1186/s12905-015-0196-z
23. Endometrioz: klinicheskie rekomendatsii Minzdrava Rossii. 2020. Available at: https://cr.minzdrav.gov.ru/recomend/259_1. Accessed: 05.09.2023 (in Russian).
24. Tomassetti C, Johnson NP, Petrozza J, et al. An international terminology for endometriosis. Facts Views Vis Obgyn. 2021;13(4):295-304. DOI:10.52054/FVVO.13.4.036
25. Johnson NP, Hummelshoj L, Adamson GD, et al. World Endometriosis Society consensus on the classification of endometriosis. Hum Reprod. 2017;32(2):315-24. DOI:10.1093/humrep/dew293
26. Vigueras Smith A, Cabrera R, Trippia C, et al. Indirect and atypical imaging signals of endometriosis: A wide range of manifestations. Facts Views Vis Obgyn. 2021;13(4):339-56. DOI:10.52054/FVVO.13.4.048
27. Sud S, Buxi TBS, Sheth S, Ghuman SS. Endometriosis and Its Myriad Presentations: Magnetic Resonance Imaging-Based Pictorial Review. Indian J Radiol Imaging.
2021;31(1):193-202. DOI:10.1055/s-0041-1729670
28. Baușic A, Coroleucă C, Coroleucă C, et al. Transvaginal Ultrasound vs Magnetic Resonance Imaging (MRI) Value in Endometriosis Diagnosis. Diagnostics (Basel). 2022;12(7):1767. DOI:10.3390/diagnostics12071767
29. Bazot M, Thomassin I, Hourani R, et al. Diagnostic accuracy of transvaginal sonography for deep pelvic endometriosis. Ultrasound Obstet Gynecol. 2004;24(2):180-5. DOI:10.1002/uog.1108
30. Guerriero S, Condous G, van den Bosch T, et al. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound Obstet Gynecol. 2016;48(3):318-32. DOI:10.1002/uog.15955
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1ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. акад. В.И. Кулакова» Минздрава России, Москва, Россия; 2ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*aalievapm@gmail.com
________________________________________________
Alina E. Solopova1, Patimat M. Alieva*1, Madina R. Dumanovskaya1, Guzal I. Tabeeva1, Iuliia A. Ivannikova2, Antonina A. Smetnik1, Stanislav V. Pavlovich1,2
1Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia; 2Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*aalievapm@gmail.com