Modern principles of medical treatment for endometriosis at an early reproductive age


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Abstract

It is generally accepted that the priority in the choice of treatment belongs to drug therapy, since an adequately and timely selected regimen can prevent the need for surgery. To date, there is no universal approach to medical treatment for endometriosis. However, given that drugs control, but do not cure the disease, long-term pharmacological treatment may be required until pregnancy or, sometimes, physiological menopause occurs. This review presents the current state of the problem of medical treatment for endometriosis and the available clinical guidelines on this topic, including in the treatment of early reproductive-aged patients. It summarizes currently available information on approaches to treating endometriosis. The review discusses the drug groups that show the highest efficacy in treating endometriosis and dysmenorrhea associated with endometriosis (gestagens, combined oral contraceptives, gonadotropin-releasing hormone agonists), as well as the promising drugs that go through clinical trials (selective progesterone and estrogen receptor modulators, metformin, statins, cabergoline, etc.). Particular attention is paid to the mechanisms of anti-endometrioid action of gestagens, which is associated not only with the induction of endometrial decidualization, but also with anti-inflammatory and immunomodulatory effects, the decrease in the transcription of neuro- and angiogenic factors, and the suppression of the proliferative activity of foci and trophism to the latter, by inhibiting the growth of blood vessels and nerves. Conclusion: The available treatment regimens for endometriosis combine symptomatic and pathogenic effects that determine the long-term efficacy, safety profile, and rationale, starting from the diagnosis at an early reproductive age.

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About the authors

Elena P. Khashchenko

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology Ministry of Health of the Russian Federation

Email: khashchenko_elena@mail.ru
PhD, Senior Researcher of 2nd Gynecological (child and adolescent) Department 117997, Russia, Moscow, Ac. Oparina str., 4

Anastasia S. Sivirinova

M.V. Lomonosov Moscow State University

Email: sivirinovaa@gmail.com
student, Faculty of Fundamental Medicine 119991, Russia, Moscow, Leninskye Gory, 1

Elena V. Uvarova

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology Ministry of Health of the Russian Federation; I.M. Sechenov First Moscow State Medical University Ministry of Health of the Russian Federation (Sechenov University)

Email: elena-uvarova@yandexru
Dr. Med. Sci., Professor, Corresponding Member of the RAS, Head of 2nd Gynecological (child and adolescent) Department 117997, Russia, Moscow, Ac. Oparina str., 4

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