The role of sensitization to progesterone in improving the treatment of endometriosis-associated pelvic pain

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Abstract

Objective: To evaluate the effectiveness of complex treatment of patients with endometriosis and chronic pelvic pain (CPP) considering the preliminary diagnosis of their sensitization to progesterone.

Materials and methods: The study included 100 women of reproductive age with confirmed endometriosis and CPP. The patients of the main group were divided into four subgroups depending on the results of the diagnosis of sensitization to progesterone and on the administered hormone therapy with dienogest and dydrogesterone (group 1: sensitization to progesterone – surgical treatment+dienogest; group 2: sensitization to progesterone – surgical treatment + dydrogesterone; group 3: without sensitization to progesterone – surgical treatment+dienogest; group 4: without sensitization to progesterone – surgical treatment+dydrogesterone). Six months after surgery and therapy there was an assessment of the dynamics of pain intensity using a visual analogue scale (VAS).

Results: There was a statistically significant decrease in pain on the VAS scale in all four subgroups of patients who had experienced CPP, dysmenorrhea, and dyspareunia. A decrease in CPP and dyspareunia in patients with sensitization to progesterone was more significant in the subgroup that was treated with hormone therapy with dydrogesterone. A decrease in dysmenorrhea was not different in patients who were treated with dydrogesterone and dienogest.

Conclusion: The most effective option for postoperative treatment of endometriosis for patients with CPP and sensitization to progesterone is the therapy with dydrogesterone. The high selectivity of dydrogesterone to progesterone receptors provides clinical efficacy and a favorable safety profile of the medication.

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About the authors

Vitaly F. Bezhenar

Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia

Author for correspondence.
Email: bez-vitaly@yandex.ru
ORCID iD: 0000-0002-7807-4929

Dr. Med. Sci., Professor, Head of the Department of Obstetrics, Gynecology and Neonatology/Reproductology, Head of the Clinic of Obstetrics and Gynecology

Russian Federation, 197022, St. Petersburg, Leo Tolstoy str., 6-8

Oleg L. Molchanov

Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia

Email: moleg700@mail.ru
ORCID iD: 0000-0003-3882-1720

Dr. Med. Sci., Professor at the Department of Obstetrics, Gynecology and Reproductology

Russian Federation, 197022, St. Petersburg, Leo Tolstoy str., 6-8

Vlavimir L. Pastushenkov

Saint Petersburg Research Institute of Ear, Throat, Nose and Speech, Ministry of Health of Russia

Email: pastprof@mail.ru
ORCID iD: 0000-0002-4957-0181

Dr. Med. Sci., Professor, Chief Researcher

Russian Federation, 190013, St. Petersburg, Bronnitskaya str., 9

Alina S. Konstandenkova

Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia

Email: dr.konstandenkova@gmail.com
ORCID iD: 0000-0002-6362-107X

postgraduate student of the Department of Obstetrics, Gynecology and Reproductology

Russian Federation, 197022, St. Petersburg, Leo Tolstoy str., 6-8

Natalya S. Kuzmina

Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia

Email: bez-vitaly@yandex.ru
ORCID iD: 0000-0002-1675-4144

PhD, Assistant at the Department of Obstetrics, Gynecology and Neonatology, Head of the Department of Oncogynecology No. 7 of the Clinic of Obstetrics and Gynecology

Russian Federation, 197022, St. Petersburg, Leo Tolstoy str., 6-8

Svyatoslav Yu. Kruglov

Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia

Email: skruglov89@mai.ru

PhD, Assistant at the Department of Obstetrics, Gynecology and Reproductology

Russian Federation, 197022, St. Petersburg, Leo Tolstoy str., 6-8

Ana G. Gramatikova

Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia

Email: frau.gramatikova@yandex.ru
ORCID iD: 0000-0001-7463-1831

postgraduate student of the Department of Obstetrics, Gynecology and Neonatology

Russian Federation, 197022, St. Petersburg, Leo Tolstoy str., 6-8

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