Endometriosis

• Devyatova E.A.

Abstract

Objective. Endometriosis is a progressive estro gendependent widely spread disease especially among women suffering of chronic pelvic pain (40–80 %) and infertility (25–80 %). Pathogenesis is multifactored, but ectopic dissemination of endometrial tissue with forming of endometrioid implants is doubtless. The role of stem cells in its pathogenesis is proved. The choice of therapeutic approaches is wide, however the unique approach has not been worked out yet. The management is determined with the aim of therapy (treatment of pelvic pain or infertility).

Aims: 1) stem cells and angiogenesis involvement in pathophysiology of endometriosis; 2) comparison of effectiveness for different approach in endometriosis treatment; 3) to analyze the validity of recently created pharmacologic agents for endometriosis treatment.

Materials and methods. To form the review devoted to endometriosis problem PubMed, EMBASE, MedLine and the Cochrane Library were searched for randomised trials in 2013–2014, limited to the English literature.

Results. Laparoscopic surgery and excision of endometriomas are associated with decreasing pelvic pain. Therefore there is a number of patients for those surgery is the primary approach in endometriosis treatment. Bowel endometriosis is conjugated with severe pelvic pain and high risk of complicated surgery. Pharmacological agents (Gonadotrophin-Releasing Hormone analogs, progestagens, oral contraceptive pills, androgens, non-steroid anti-inflammatory drugs, etc.) are commonly applied ongoing for endometriosis of various location. They control pelvic pain syndrome effectively, but every of them has its advantages and disadvantages.

Conclusion. Elagolix treatment may become the basis of new strategy, which core is partial estrogen depression, therefore further research is required. Angiogenesis inhibition also represents a new line in endometriosis management. Sorafenib effects on stem cells proliferation, invasion and HIF-1 activation help to suppose new possibilities for its application. Anti-angiogenic drugs may show good result separate or being combined with hormone therapy and provide high efficacy of complex pharmacological approach.

Keywords:pelvic pain, endometriosis, infertility, stem cells, Gonadotrophin- Releasing Hormone analogs, dienogest, oral contraceptive pills, elagolix, sorafenib

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