Pathogenesis, diagnosis, and treatment of genital endometriosis: current state of the issue

封面

如何引用文章

全文:

开放存取 开放存取
受限制的访问 ##reader.subscriptionAccessGranted##
受限制的访问 订阅或者付费存取

详细

Endometriosis is the most common condition in young women. This review presents the analysis of the recent studies on the etiology, pathogenesis of the disease, and risk factors for its development. The search for non-invasive markers for the early diagnosis of endometriosis led to the involvement of artificial intelligence and the development of specialised software. In order to meet the needs of the practitioner, the classification of endometriosis has been modernized. The search for drugs aimed at pathogenetic treatment of the disease as well as its prevention with high safety and efficacy continues. Every year there are improvements in surgical techniques using artificial intelligence and robotics.

Conclusion: There is a high need for basic research on the endometriosis pathophysiology in the fields of genomics, proteomics, transcriptomics, metabolomics, combined with the study of the characteristics of immunological surveillance and endocrine dysregulation. This type of research would help clarify the specific mechanisms of endometriosis pathogenesis and identify new diagnostic and therapeutic targets.

全文:

受限制的访问

作者简介

Angelina Krasilnikova

V.N. Gorodkov Ivanovo Research Institute of Maternity and Childhood, Ministry of Health of Russia

编辑信件的主要联系方式.
Email: brasilia71@mail.ru
ORCID iD: 0000-0001-7839-3893

Dr. Med. Sci., Senior Researcher at the Department of Obstetrics and Gynecology

俄罗斯联邦, 153045, Ivanovo, Pobedy str., 20

Elena Boyko

V.N. Gorodkov Ivanovo Research Institute of Maternity and Childhood, Ministry of Health of Russia

Email: Dr-Boyko@mail.ru
ORCID iD: 0000-0002-8907-4860

Dr. Med. Sci., Senior Researcher at the Department of Obstetrics and Gynecology

俄罗斯联邦, 153045, Ivanovo, Pobedy str., 20

Anna Malyshkina

V.N. Gorodkov Ivanovo Research Institute of Maternity and Childhood, Ministry of Health of Russia

Email: anna_im@mail.ru
ORCID iD: 0000-0002-1145-0563

Dr. Med. Sci., Professor, Director

俄罗斯联邦, 153045, Ivanovo, Pobedy str., 20

参考

  1. Министерство здравоохранения Российской Федерации. Клинические рекомендации. Эндометриоз. М.; 2020. 32с. [Ministry of Health of the Russian Federation. Clinical guidelines. Endometriosis. M.; 2020. 32p. (in Russian)].
  2. Wettstein M., Imesch P., Witzel I., Metzler J.M. Evolution of endometriosis research: A comprehensive analysis of research designs and topics over the last 15 years. Journal of Endometriosis and Uterine Disoders. 2024; 7: 100076. https://dx.doi.org/10.1016/j.jeud.2024.100076.
  3. Watson C. Surge in endometriosis research after decades of underfunding could herald new era for women's health. Nat. Med. 2024; 30(2): 315-8. https://dx.doi.org/10.1038/s41591-024-02795-0.
  4. Герасимов А.М., Малышкина А.И., Кулигина М.В, Красильникова А.К., Полумисков Д.М., Абдуллаева Л.Х., Фадеева Е.В., Двойнова И.Ю. Частота встречаемости и структура наружного генитального эндометриоза у госпитализированных больных. Гинекология. 2021; 23(2): 184-9. [Gerasimov A.M., Malyshkina A.I., Kuligina M.V., Krasilnikova A.K., Polumiskov D.M., Abdullaeva L.Kh., Fadeeva E.V., Dvoinova I.Yu. Incidence rate and structure of external genital endometriosis in hospital patients. Gynecology. 2021; 23(2): 184-9. (in Russian)]. https://dx.doi.org/10.26442/ 20795696.2021.2.200783.
  5. Ghiasi M., Kulkarni M.T., Missmer S.A. Is endometriosis more common and more severe than it was 30 years ago? J. Minim. Invasive Gynecol. 2020; 27(2): 452-61. https://dx.doi.org/10.1016/j.jmig.2019.11.018.
  6. Simopoulou M., Rapani A., Grigoriadis S., Pantou A., Tsioulou P., Maziotis E. 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. https://dx.doi.org/10.3390/biomedicines9030273.
  7. Фетисова И.Н., Малышкина А.И., Бойко Е.Л., Семененко С.С., Фетисов Н.С., Полумискова Е.В., Ратникова С.Ю. Способ прогнозирования анеуплоидии эмбрионов в программе экстракорпорального оплодотворения у женщин с эндометриоз-ассоциированным бесплодием. Патент РФ № RU 2752783 C1. Заявитель и патентообладатель: ФГБУ «Ивановский научно-исследовательский институт материнства и детства имени В.Н. Городкова» Министерства здравоохранения Российской Федерации. № 2020141979; заявл. 18.12.2020; опубл. 03.08.2021. Бюл. № 22. [Fetisova I.N., Malyshkina A.I., Boyko E.L., Semenenko S.S., Fetisov N.S., Polumiskova E.V., Ratnikova S.Yu. Method for predicting embryo aneuploidy in vitro fertilization program in women with endometriosis-associated infertility. RF Patent No. RU 2752783 C1. Applicant and patent holder: FSBI "Ivanovo Research Institute of Motherhood and Childhood named after V.N. Gorodkov" of the Ministry of Health of the Russian Federation. № 2020141979; declared 18.12.2020; publ. 03.08.2021. Bul. № 22. (in Russian)].
  8. Perrone U., Ferrero S., Gazzo I., Izzotti A., Leone Roberti Maggiore U., Gustavino C. et al. Endometrioma surgery: Hit with your best shot (But know when to stop). Best Pract. Res. Clin. Obstet. Gynaecol. 2024; 96: 102528. https:// dx.doi.org/10.1016/j.bpobgyn.2024.102528.
  9. Bulun S.E., Yilmaz B.D., Sison C., Miyazaki K., Bernardi L., Liu S. et al. Endometriosis. Endocr. Rev. 2019; 40(4): 1048-79. https://dx.doi.org/10.1210/er.2018-00242.
  10. Беженарь В.Ф., Рогатинская Е.В., Дьяченко Д.Т., Федосова Д.В. Беременность и роды у пациенток с эндометриозом. Журнал акушерства и женских болезней. 2023; 72(2): 63-70. [Bezhenar V.F., Rogatinskaya E.V., Dyachenko D.T., Fedosova D.V. Pregnancy and childbirth in patients with endometriosis. Journal of Obstetrics and Women’s Diseases. 2023; 72(2): 63-70. (in Russian)]. https://dx.doi.org/10.17816/JOWD109303.
  11. Пономарева Т.А., Алтухова О.Б., Пономаренко И.В., Чурносов М.И. Современные представления о механизмах развития и факторах риска эндометриоза. Акушерство и гинекология. 2024; 7: 12-20. [Ponomareva T.A., Altukhova O.B., Ponomarenko I.V., Churnosov M.I. Novel concepts in the pathogenesis and risk factors of endometriosis. Obstetrics and Gynecology. 2024; (7): 12-20 (in Russian)]. https://dx.doi.org/10.18565/aig.2024.110.
  12. Bulun S.E. Endometriosis caused by retrograde menstruation: now demonstrated by DNA evidence. Fertil. Steril. 2022; 118(3): 535-6. https:// dx.doi.org/10.1016/j.fertnstert.2022.07.012.
  13. Koninckx P.R., Ussia A., Adamyan L., Wattiez A., Gomel V., Martin D.C. Pathogenesis of endometriosis: the genetic/epigenetic theory. Fertil. Steril. 2019; 111(2): 327-40. https://dx.doi.org/10.1016/j.fertnstert.2018.10.013.
  14. Rahmioglu N., Mortlock S., Ghiasi M., Møller P.L., Stefansdottir L., Galarneau G. et al. The genetic basis of endometriosis and comorbidity with other pain and inflammatory conditions. Nat. Genet. 2023; 55(3): 423-36. https:// dx.doi.org/10.1038/s41588-023-01323-z.
  15. Bulun S.E., Yildiz S., Adli M., Chakravarti D., Parker J.B., Milad M. et al. Endometriosis and adenomyosis: shared pathophysiology. Fertil. Steril. 2023; 119(5): 746-50. https://dx.doi.org/10.1016/j.fertnstert.2023.03.006.
  16. Адамян Л.В., Арсланян К.Н., Логинова О.Н., Манукян Л.М., Харченко Э.И. Иммунологические аспекты эндометриоза. Обзор литературы. Лечащий врач. 2020; 4: 37-47. [Adamyan L.V., Arslanyan K.N., Loginova O.N., Manukyan L.M., Kharchenko E.I. Immunological aspects of endometriosis: review of the literature. Lechaschi Vrach Journal. 2020; (4): 37-47 (in Russian)]. https://dx.doi.org/10.26295/OS.2020.29.10.007.
  17. Красильникова А.К., Абдуллаева Л.Х., Малышкина А.И., Сотникова Н.Ю., Анциферова Ю.С. Особенности регуляции гуморального иммунного ответа на системном и локальном уровнях при эндометриозе. Таврический медико-биологический вестник. 2017; 20(2): 58-62. [Krasil’nikova A.K., Abdullaeva L.Kh., Malyshkina A.I., Sotnikova N.Yu., Antsiferova Yu.S. Features of the regulation of the humoral immune response at the systemic and local levels in endometriosis. Tauride Medical and Biological Bulletin. 2017; 20(2): 58-62. (in Russian)].
  18. Красильникова А.К., Малышкина А.И., Сотникова Н.Ю., Анциферова Ю.С. Особенности функционального состояния фагоцитов крови у пациенток с эндометриозом I-II стадии и бесплодием. Российский вестник акушера-гинеколога. 2017; 17(3): 9-14. [Krasil'nikova A.K., Malyshkina A.I., Sotnikova N.Yu., Antsiferova Iu.S. The functional state of phagocytes in patients with Stage I-II endometriosis and infertility. Russian Bulletin of Obstetrician-Gynecologist. 2017; 17(3): 9-14. (in Russian)]. https://dx.doi.org/10.17116/rosakush20171739-14.
  19. Ярмолинская М.И., Адамян Л.В. Эндометриоз-ассоциированный болевой синдром и спаечный процесс – новые аспекты патогенеза и возможности терапии. Проблемы репродукции. 2023; 29(2): 93-100. [Yarmolinskaya M.I., Adamyan L.V. Endometriosis-associated pain and adhesions – new pathogenetic aspects and therapeutic approach. Russian Journal of Human Reproduction. 2023; 29(2): 93-100. (in Russian)]. https://dx.doi.org/10.17116/repro20232902193.
  20. Allaire C., Bedaiwy M.A., Yong P.J. Diagnosis and management of endometriosis. CMAJ. 2023; 195(10): 363-71. https://dx.doi.org/10.1503/ cmaj.220637.
  21. Манагадзе И.Д., Нестерова А.А., Левакова О.С., Леваков С.А. Психоэмоциональные аспекты и соматический статус женщины с эндометриозом – есть ли связь? Акушерство и гинекология. 2024; 11: 21-33. [Managadze I.D., Nesterova A.A., Levakova O.S., Levakov S.A. Psychoemotional aspects and somatic status of women with endometriosis: is there a link? Obstetrics and Gynecology. 2024; (11): 21-33 (in Russian)]. https://dx.doi.org/10.18565/aig.2024.185.
  22. Красильникова А.К., Герасимов А.М., Абдуллаева Л.Х. Факторы риска и клинико-анамнестические особенности у женщин с эндометриоз-ассоциированным бесплодием в современных условиях. Научное обозрение. Медицинские науки. 2022; 6: 23-8. [Krasilnikova A.K., Gerasimov A.M., Abdullaeva L.Kh. Risk factors and clinical anamnestic features in women with endometriosis-associated infertility in modern conditions. Science-review. Medical sciences. 2022; 6: 23-8. (in Russian)].
  23. Cho H.H., Yoon Y.S. Development of an endometriosis self-assessment tool for patient. Obstet. Gynecol. Sci. 2022; 65(3): 256-65. https://dx.doi.org/10.5468/ogs.21252.
  24. El-Hadad S., Lässer D., Sachs M.K., Schwartz A.S.K., Haeberlin F., von Orelli S. et al. Dysmenorrhea in adolescents requires careful investigation of endometriosis-an analysis of early menstrual experiences in a large case-control study. Front. Reprod. Health. 2023; 5: 1121515. https://dx.doi.org/10.3389/frph.2023.1121515.
  25. Hansen K.E., Lambek R., Røssaak K., Egekvist A.G., Marschall H., Forman A. et al. Health-related quality of life in women with endometriosis: psychometric validation of the Endometriosis Health Profile 30 questionnaire using confirmatory factor analysis. Hum. Reprod. Open. 2021; 2022(1): hoab042. https://dx.doi.org/10.1093/hropen/hoab042.
  26. Cetera G.E., Merli C.E.M., Barbara G., Caia C., Vercellini P. Questionnaires for the assessment of central sensitization in endometriosis: what is the available evidence? A systematic review with a narrative synthesis. Reprod. Sci. 2024; 31(3): 633-44. https://dx.doi.org/10.1007/s43032-023-01343-4.
  27. Nijs J., Leysen L., Vanlauwe J., Logghe T., Ickmans K., Polli A. et al. Treatment of central sensitization in patients with chronic pain: time for change? Expert Opin. Pharmacother. 2019; 20(16): 1961-70. https://dx.doi.org/10.1080/ 14656566.2019.1647166.
  28. Леваков С.А., Громова Т.А., Титова Н.Р., Грибков С.В., Манагадзе И.Д. Первый отечественный опыт применения технологии наблюдения реальности при эндометриозе. Акушерство и гинекология. 2025; 1: 82-7. [Levakov S.A., Gromova T.A., Titova N.R., Gribkov S.V., Managadze I.J. First domestic experience of VR-intervention in endometriosis. Obstetrics and Gynecology. 2025; (1): 82-7 (in Russian)]. https://dx.doi.org/10.18565/aig.2024.187.
  29. Gkrozou F., Tsonis O., Sorrentino F., Nappi L., Vatopoulou A., Skentou C. et al. Endometriosis predictive models based on self-assessment questionnaire, evidence from clinical examination or imaging findings: a narrative review. J. Cin. Med. 2024; 13(2): 356. https://dx.doi.org/10.3390/ jcm13020356.
  30. Guerriero S., Ajossa S., Pagliuca M., Borzacchelli A., Deiala F., Springer S. et al. Advances in imaging for assessing pelvic endometriosis. Diagnostics (Basel). 2022; 12(12): 2960. https://dx.doi.org/10.3390/diagnostics12122960.
  31. Адамян Л.В., Соколов А.Д., Аветисян Д.С., Шаповаленко Р.А. Современные методы диагностики аденомиоза: систематический обзор. Проблемы репродукции. 2023; 29(3): 81-90. [Adamyan L.V., Sokolov A.D., Avetisyan Ju.S., Shapovalenko R.A. Methods of diagnostics of adenomyosis: a systematic review. Russian Journal of Human Reproduction. 2023; 29(3): 81-90. (in Russian)]. https://dx.doi.org/10.17116/repro20232903181.
  32. Moustafa S., Burn M., Mamillapalli R., Nematian S., Flores V., Taylor H.S. Accurate diagnosis of endometriosis using serum microRNAs. Am. J. Obstet. Gynecol. 2020; 223(4): 557.e1-11. https://dx.doi.org/10.1016/ j.ajog.2020.02.050.
  33. Bendifallah S., Suisse S., Puchar A., Delbos L., Poilblanc M., Descamps P. et al. Salivary MicroRNA signature for diagnosis of endometriosis. J. Clin. Med. 2022; 11(3): 612. https://dx.doi.org/10.3390/jcm11030612.
  34. Tomassetti C., Johnson N.P., Petrozza J., Abrao M.S., Einarsson J.I., Horne A.W.; International working group of AAGL, ESGE, ESHRE and WES. An International Terminology for Endometriosis, 2021. J. Minim. Invasive Gynecol. 2021; 28(11): 1849-59. https://dx.doi.org/10.1016/ j.jmig.2021.08.032.
  35. Johnson N.P., Hummelshoj L., Adamson G.D., Keckstein J., Taylor H.S., Abrao M.S. et al.; World Endometriosis Society Sao Paulo Consortium. World Endometriosis Society consensus on the classification of endometriosis. Hum. Reprod. 2017; 32(2): 315-24. https://dx.doi.org/10.1093/humrep/dew293.
  36. Айламазян Э.К., Ярмолинская М.И., Молотков А.С., Цицкарава Д.З. Классификации эндометриоза. Журнал акушерства и женских болезней. 2017; 66(2): 77-92. [Aylamazyan E.K., Yarmolinskaya M.I., Molotkov A.S., Tsitskarava D.Z. Classifications of endometriosis. Journal of Obstetrics and Women's Diseases. 2017; 66(2): 77-92. (in Russian)]. https:// dx.doi.org/10.17816/JOWD66277-92.
  37. Адамян Л.В., Арсланян К.Н., Харченко Э.И., Логинова О.Н. Современные направления в медикаментозном лечении эндометриоза. Проблемы репродукции. 2019; 25(6): 58-66. [Adamyan L.V., Arslanyan K.N., Kharchenko E.I., Loginova O.N. Modern trends in the treatment of endometriosis. Russian Journal of Human Reproduction. 2019; 25(6): 58-66. (in Russian)]. https://dx.doi.org/10.17116/repro20192506158
  38. Ярмолинская М.И., Адамян Л.В. Гормональные контрацептивы и эндометриоз: современный взгляд на проблему. Проблемы репродукции. 2020; 26(3): 39-45. [Yarmolinskaya M.I., Adamyan L.V. Hormonal contraceptives and endometriosis: modern view on the problem. Russian Journal of Human Reproduction. 2020; 26(3): 39-45. (in Russian)]. https://dx.doi.org/10.17116/repro20202603139.
  39. Saunders P.T.K., Horne A.W. Endometriosis: Etiology, pathobiology, and therapeutic prospects. Cell. 2021; 184(11): 2807-24. https:// dx.doi.org/10.1016/j.cell.2021.04.041.
  40. Дурнева Е.И., Соколов Д.И., Ярмолинская М.И., Сельков С.А. Интерфероны: патогенетическое обоснование при лечении наружного генитального эндометриоза и клиническая эффективность. Журнал акушерства и женских болезней. 2019; 68(1): 47-58. [Durneva E.I., Sokolov D.I., Yarmolinskaya M.I., Selkov S.A. Interferons: pathogenetic rationale for the treatment of external genital endometriosis and clinical efficacy. Journal of Obstetrics and Women's Diseases. 2019; 68(1): 47-58 (in Russian)]. https:// dx.doi.org/10.17816/JOWD68147-58.
  41. Красильникова А.К., Малышкина А.И., Сотникова Н.Ю., Абдуллаева Л.Х. Прогнозирование эффективности хирургического лечения бесплодия у женщин с «малыми» формами генитального эндометриоза – от теории к практике. Акушерство и гинекология. 2020; 11: 100-6. [Krasilnikova A.K., Malyshkina A.I., Sotnikova N.Yu., Abdullaeva L.Kh. Prediction of the efficiency of surgical treatment for infertility in women with minor forms of genital endometriosis – from theory to practice. Obstetrics and Gynecology. 2020; (11): 100-6 (in Russian)]. https://dx.doi.org/10.18565/aig.2020.11.100-106.
  42. Ярмолинская М.И., Дурнева Е.И., Чепанов С.В., Соколов Д.И., Сельков С.А. Рекомбинантный интерлейкин-2: клиническая эффективность и патогенетическое обоснование применения при наружном генитальном эндометриозе. Проблемы репродукции. 2021; 27(2): 41-50. [Yarmolinskaya M.I., Durneva E.I., Chepanov S.V., Sokolov D.I., Selkov S.A. Recombinant IL-2: clinical efficacy and pathogenetic rationale for use in external genital endometriosis. Russian Journal of Human Reproduction. 2021; 27(2): 41-50. (in Russian)]. https://dx.doi.org/10.17116/repro20212702141.
  43. Li W., Lin A., Qi L., Lv X., Yan S., Xue J. et al. Immunotherapy: A promising novel endometriosis therapy. Front. Immunol. 2023; 14: 1128301. https:// dx.doi.org/10.3389/fimmu.2023.1128301.
  44. Centofanti F., Buono A., Verboni M., Tomino C., Lucarini S., Duranti A. et al. Synthetic methodologies and therapeutic potential of Indole-3-Carbinol (I3C) and its derivatives. Pharmaceuticals. 2023; 16(2): 240. https:// dx.doi.org/10.3390/ph16020240.
  45. Kalaitzopoulos D.R., Samartzis N., Daniilidis A., Leeners B., Makieva S., Nirgianakis K. et al. Effects of vitamin D supplementation in endometriosis: a systematic review. Reprod. Biol. Endocrinol. 2022; 20(1): 176. https:// dx.doi.org/10.1186/s12958-022-01051-9.
  46. Meresman G.F., Gotte M., Laschke M.W. Plants as source of new therapies for endometriosis: a review of preclinical and clinical studies. Hum. Reprod. Update. 2021; 27(2): 367-392. https://dx.doi.org/10.1093/humupd/dmaa039.
  47. Адамян Л.В., Припутневич Т.В., Григорян И.Э., Соколов А.Д. Вклад микробиоты эндометрия в развитие эндометриоза и аденомиоза у женщин репродуктивного возраста. Проблемы репродукции. 2022; 28(6): 170-4. [Adamyan L.V., Priputnevich T.V., Grigorian I.E., Sokolov A.D. The contribution of the endometrial microbiota to the development of endometriosis and adenomyosis in women of reproductive age. Russian Journal of Human Reproduction. 2022; 28(6):170-4. (in Russian)]. https://dx.doi.org/10.17116/repro202228061170.
  48. ESHRE. Endometriosis. Guideline of European Society of Human Reproduction and Embriology. ESHRE Endometriosis Guideline Development Group; 2022. Available at: https://www.bsge.org.uk/wp-content/uploads/2022/02/ESHRE-GUIDELINE-ENDOMETRIOSIS-2022.pdf
  49. Адамян Л.В., Арсланян К.Н., Сонова М.М., Харченко Э.И., Логинова О.Н., Ласкевич А.В., Гапарова А.А. Современные тенденции в хирургическом лечении инфильтративных форм эндометриоза. Проблемы репродукции. 2019; 25(5): 36-41. [Adamyan L.V., Arslanyan K.N., Sonova M.M., Kharchenko E.I., Loginova O.N., Laskevich A.V., Gaparova A.A. Current trends in the surgical treatment of infiltrative forms of endometriosis. Russian Journal of Human Reproduction. 2019; 25(5): 36-41. (in Russian)]. https://dx.doi.org/10.17116/repro20192505136.
  50. Massimello F., Di Spiezio Sardo A., Bifulco G., Angioni S.S., Cela V. New technologies in the surgical management of endometriosis. AboutOpen. 2023; 10(1): 50-4. https://dx.doi.org/10.33393/ao.2023.2547.

补充文件

附件文件
动作
1. JATS XML
下载

版权所有 © Bionika Media, 2025