Инновации в диагностике и терапии эндометриоза: от достижений настоящего к прогрессивному взгляду в будущее

Оразов М.Р., Радзинский В.Е., Долгов Е.Д. Инновации в диагностике и терапии эндометриоза: от достижений настоящего к прогрессивному взгляду в будущее. Гинекология. 2025;27(4):281–286. DOI: 10.26442/20795696.2025.4.203490

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Orazov MR, Radzinsky VE, Dolgov ED. Innovations in the diagnosis and treatment of endometriosis: from the current advancements to a future outlook: A review. Gynecology. 2025;27(4):281–286. DOI: 10.26442/20795696.2025.4.203490

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Аннотация

Поиск современных подходов к диагностике и лечению эндометриоза остается одним из приоритетных вопросов современной гинекологии. Чрезвычайно высокие показатели распространенности данного заболевания, его пагубное влияние на соматическое и репродуктивное здоровье, а также качество жизни пациенток определяют необходимость долгосрочной терапии. В статье отражены доказанные и регламентированные современными гайдлайнами подходы к клиническому менеджменту пациенток, страдающих эндометриозом. В настоящее время в арсенале современного клинициста имеется ряд доказанных технологий для эффективного клинического менеджмента (купирования болевого синдрома, преодоления бесплодия, контроля прогрессирования и рецидивов болезни и качества жизни) пациенток данной когорты. Одна из таких технологий – использование «золотого стандарта» фармакотерапии эндометриоза прогестагенов, а именно диеногеста 2 мг, не только доказанно купирующего симптомы, но и эффективно контролирующего его прогрессирующее и рецидивирующее течение. Рассмотрены также ближайшие и отдаленные перспективы диагностики и лечения эндометриоза, в частности препаратов с с антиангиогенным механизмом действия, потенциально способных изменить прогноз пациенток с этим заболеванием.

Ключевые слова: эндометриоз, диеногест, инновационное лечение, реальная клиническая практика

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The search for approaches to diagnosing and treating endometriosis remains a priority in modern gynecology. The extremely high prevalence of this condition and its detrimental effect on somatic and reproductive health and the quality of life of patients determine the need for long-term therapy. The article describes evidence-based, modern guidelines-regulated approaches to the clinical management of patients with endometriosis. Currently, the arsenal of a modern clinician includes several technologies for effective clinical management of such patients (pain management, infertility treatment, monitoring the progression and recurrence of the disease, and quality of life). One such approach is the use of the “gold standard” pharmacotherapy for endometriosis with progestogens, namely dienogest 2 mg, which has been proven not only to relieve symptoms but also to effectively control endometriosis progression and recurrence. The immediate and long-term prospects for the diagnosis and treatment of endometriosis, in particular, drugs with an anti-angiogenic mechanism of action that can potentially change the prognosis of patients with this disease, are also considered.

Keywords: endometriosis, dienogest, innovative treatment, real-world practice

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Список литературы

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26. Bono Y, Kyo S, Kiyono T, et al. Concurrent estrogen action was essential for maximal progestin effect in oral contraceptives. Fertil Steril. 2014;101(5):1337-43. DOI:10.1016/j.fertnstert.2014.02.005
27. Hirata T, Koga K, Osuga Y. Extra-pelvic endometriosis: A review. Reprod Med Biol. 2020;19(4):323-33. DOI:10.1002/rmb2.12340
28. Shi J, Qi Y, Sun Y, Huang Y. Kallikrein-related peptidase 4 promotes proliferation, migration, invasion, and pro-angiogenesis of endometrial stromal cells via regulation of brain-derived neurotrophic factor production in endometriosis. Am J Pathol. 2024;194(1):121-34. DOI:10.1016/j.ajpath.2023.10.006
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30. Bo C, Wang Y. Angiogenesis signaling in endometriosis: Molecules, diagnosis and treatment. Mol Med Rep. 2024;29(3):43. DOI:10.3892/mmr.2024.13167

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1. Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 2020;382(13):1244-56. DOI:10.1056/NEJMra1810764
2. Huang JQ, Lathi RB, Lemyre M, et al. Coexistence of endometriosis in women with symptomatic leiomyomas. Fertil Steril. 2010;94(2):720-3. DOI:10.1016/j.fertnstert.2009.03.052
3. Nezhat C, Li A, Abed S, et al. Strong association between endometriosis and symptomatic leiomyomas. JSLS. 2016;20(3):e2016.00053. DOI:10.4293/JSLS.2016.00053
4. Nezhat C, Nezhat F, Nezhat C. Endometriosis: Ancient disease, ancient treatments. Fertil Steril. 2012;98(Suppl. 6):S1-62. DOI:10.1016/j.fertnstert.2012.08.001
5. Simopoulou M, Rapani A, Grigoriadis S, et al. Getting to know endometriosis-related infertility better: A review on how endometriosis affects oocyte quality and embryo development. Biomedicines. 2021;9(3):273. DOI:10.3390/biomedicines9030273
6. Arnold MJ, Osgood AT, Aust A. Chronic pelvic pain in women: ACOG updates recommendations. Am Fam Physician. 2021;103(3):186-8. PMID: 33507045.
7. Ruszała M, Dłuski DF, Winkler I, et al. The state of health and the quality of life in women suffering from endometriosis. J Clin Med. 2022;11(7):2059. DOI:10.3390/jcm11072059
8. Becker CM, Bokor A, Heikinheimo O, et al. ESHRE guideline: Endometriosis. Hum Reprod Open. 2022;2022(2):hoac009. DOI:10.1093/hropen/hoac009
9. Endometrioz. Klinicheskie rekomendatsii. 2024. Available at: https://cr.minzdrav.gov.ru/view-cr/259_2?ysclid=mhn3ghltx91969925. Accessed: 05.06.2025 (in Russian).
10. Chen-Dixon K, Uzuner C, Mak J, Condous G. Effectiveness of ultrasound for endometriosis diagnosis. Curr Opin Obstet Gynecol. 2022;34(5):324-31. DOI:10.1097/GCO.0000000000000812
11. 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
12. Vanhie A, Caron E, Vermeersch E, et al. Circulating microRNAs as non-invasive biomarkers in endometriosis diagnosis – A systematic review. Biomedicines. 2024;12(4):888. DOI:10.3390/biomedicines12040888
13. Bendifallah S, Dabi Y, Suisse S, et al. Saliva-based microRNA diagnostic signature for the superficial peritoneal endometriosis phenotype. Eur J Obstet Gynecol Reprod Biol. 2024;297:187-96. DOI:10.1016/j.ejogrb.2024.04.020
14. Ferrier C, Bendifallah S, Suisse S, et al. Saliva microRNA signature to diagnose endometriosis: A cost-effectiveness evaluation of the Endotest®. BJOG. 2023;130(4):396-406. DOI:10.1111/1471-0528.17348
15. Ziwig Endotest. Available at: https://ziwig.com/en/endotest/ Accessed: 05.08.2025.
16. The first endometriosis drug in four decades is on the horizon. Available at: https://www.economist.com/science-and-technology/2024/02/07/the-first-endometriosis-drug-in-four-dec.... Accessed: 05.08.2025.
17. Kim HJ, Kim SH, Oh YS, et al. Dienogest may reduce estradiol- and inflammatory cytokine-induced cell viability and proliferation and inhibit the pathogenesis of endometriosis: A cell culture- and mouse model-based study. Biomedicines. 2022;10(11):2992. DOI:10.3390/biomedicines10112992
18. Lin SC, Wang XY, Fu XL, et al. Systematic review and meta-analysis of efficacy and safety of dienogest in treatment of endometriosis. World J Meta-Anal. 2021;9(4):377-88. DOI:10.13105/wjma.v9.i4.377
19. Muzii L, Di Tucci C, Galati G, et al. The efficacy of dienogest in reducing disease and pain recurrence after endometriosis surgery: A systematic review and meta-analysis. Reprod Sci. 2023;30(11):3135-43. DOI:10.1007/s43032-023-01266-0
20. Vahid-Dastjerdi M, Hosseini R, Rodi H, et al. Comparison of the effectiveness of Dienogest with medroxyprogesterone acetate in the treatment of pelvic pain and recurrence of endometriosis after laparoscopic surgery. Arch Gynecol Obstet. 2023;308(1):149-55. DOI:10.1007/s00404-022-06898-2
21. Wu H, Liu JJ, Ye ST, et al. Efficacy and safety of dienogest in the treatment of deep infiltrating endometriosis: A meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2024;297:40-9. DOI:10.1016/j.ejogrb.2024.03.032
22. Ali MK, Hussein RS, Abdallah KS, Mohamed AA. The use of dienogest in treatment of symptomatic adenomyosis: A systematic review and meta-analysis. J Gynecol Obstet Hum Reprod. 2024;53(7):102795. DOI:10.1016/j.jogoh.2024.102795
23. Thiel PS, Donders F, Kobylianskii A, et al. The effect of hormonal treatment on ovarian endometriomas: A systematic review and meta-analysis. J Minim Invasive Gynecol. 2024;31(4):273-9. DOI:10.1016/j.jmig.2024.01.002
24. Maiorana A, Maranto M, Restivo V, et al. Evaluation of long-term efficacy and safety of dienogest in patients with chronic cyclic pelvic pain associated with endometriosis. Arch Gynecol Obstet. 2024;309(2):589-97. DOI:10.1007/s00404-023-07271-7
25. Mueck AO, Sitruk-Ware R. Nomegestrol acetate, a novel progestogen for oral contraception. Steroids. 2011;76(6):531-9. DOI:10.1016/j.steroids.2011.02.002
26. Bono Y, Kyo S, Kiyono T, et al. Concurrent estrogen action was essential for maximal progestin effect in oral contraceptives. Fertil Steril. 2014;101(5):1337-43. DOI:10.1016/j.fertnstert.2014.02.005
27. Hirata T, Koga K, Osuga Y. Extra-pelvic endometriosis: A review. Reprod Med Biol. 2020;19(4):323-33. DOI:10.1002/rmb2.12340
28. Shi J, Qi Y, Sun Y, Huang Y. Kallikrein-related peptidase 4 promotes proliferation, migration, invasion, and pro-angiogenesis of endometrial stromal cells via regulation of brain-derived neurotrophic factor production in endometriosis. Am J Pathol. 2024;194(1):121-34. DOI:10.1016/j.ajpath.2023.10.006
29. Hung SW, Gaetani M, Li Y, et al. Distinct molecular targets of ProEGCG from EGCG and superior inhibition of angiogenesis signaling pathways for treatment of endometriosis. J Pharm Anal. 2024;14(1):100-14. DOI:10.1016/j.jpha.2023.09.005
30. Bo C, Wang Y. Angiogenesis signaling in endometriosis: Molecules, diagnosis and treatment. Mol Med Rep. 2024;29(3):43. DOI:10.3892/mmr.2024.13167

Авторы

М.Р. Оразов*, В.Е. Радзинский, Е.Д. Долгов

ФГАОУ ВО «Российский университет дружбы народов им. Патриса Лумумбы», Москва, Российская Федерация
*omekan@mail.ru

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Mekan R. Orazov*, Viktor E. Radzinsky, Evgeny D. Dolgov

Peoples' Friendship University of Russia named after Patrice Lumumba, Moscow, Russian Federation
*omekan@mail.ru

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