Debating points of endometriosis
AbstractObjective. Endometriosis is a pathological process associated with benign lesions of tissue similar to endometrium in its histological and functional characteristics, outside the uterus cavity. Difficulties of management of endometriosis are attributed to a great variability of clinical presentation and severability of symptoms, the choice of tactics depends on the age of the patient, the endometriosis form and stage, manifestations of the symptoms and patient's reproductive plans. Endometriosis is considered a chronic recurrent disease demanding constant attention and treatment. It affects at least 10% of reproductive age women, but is detected in approximately 40% of infertile women and up to 90% of women with pelvic pain. The classic triad of symptoms associated with endometriosis, include dysmenorrhea, dyspareunia and dyschezia on the background of chronic pelvic pains [2]. Treatment of endometriosis should be long-term and tailored within changing priorities depending on the clinical phenotype and intensity of symptoms, patient's reproductive plans and other factors. While different kinds of medication are aimed first and foremost at pain relief, all of them have limitations associated with the degree of manifestation of side effects and cost effectiveness of treatment. Development of effective, safe and well-tolerated drugs appropriate for long-term medication is the primary task for modern gynecology.
Aims. 1) comparison of effectiveness of different methods of management of endometriosis; 2) representation of a comparative assay of pharmacological agents available for endometriosis therapy.
Materials and methods. To form the review on the endometriosis and approaches to its treatment PubMed, EMBASE, Medline, and the Cochrane Library were searched for randomized trials in 2014-2015, limited to English literature in the area.
Results. Whereas medical therapies exist for management of endometriosis related pain, each class has its limitations including side effects, cost and known duration of relief of symptoms.
Conclusion. Much has been learned about pathophysiology and pathogenesis of endometriosis and its recurrent and chronic nature, which makes this disease challenging to treat, while a complete removal of the ectopic substratum in certain amount of cases proves to be impossible. Tactics-conservative methods of therapy are successful in managing the symptoms but once discontinued the symptoms usually recur and additional interventions are required. New emerging therapies are promising but require careful evaluation for their long-lasting efficacy, tolerance and safety. A chronic suppressive therapy for management of endometriosis symptoms, particularly in the postoperative setting is recommended. Empiric treatment is appropriate in those patients without evidence of severe disease. Currently available options may not prove effective for nor well tolerated by all patients as well as not universally cost effective. Newer compounds, including gonadotropin releasing agonists and both aromatasa inhibitors and anti-angiogenic drugs combined with hormonal contraceptives, may serve as possible alternatives to previously developed and currently available therapies. Taking into consideration a high percentage of incidence of endometriosis, the increasing rate of the disease, the reproductive age of patients and a vast number of sterile marriages additional research is required for a deeper study of endometriosis progression mechanisms and its recurrence triggers.
Keywords:endometriosis, gonadotropin releasing hormone agonists, aromatase inhibitors, combined hormonal contraceptives, levonorgestrel releasing intrauterine system, non-steroidal anti-inflammatory drugs, progestins, vascular endothelial growth factor, selective progesterone receptor modulators, selective estrogen receptor modulators, danazol, mifepriston, elagolix, dienogest