medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2022-001medsovet-7277Research ArticleГИНЕКОЛОГИЯGYNECOLOGYТактика выбора гормональной терапии при эндометриозе у пациенток репродуктивного возрастаThe issues of endometriosis hormonal treatment in reproductive age womenhttps://orcid.org/0000-0003-0751-7566ИвановИ. А.IvanovI. A.

Иванов Илья Андреевич, к.м.н., научный сотрудник 

117997, Москва, ул. Академика Опарина, д. 4

Ilya A. Ivanov, Cand. Sci. (Med.), Researcher 

4, Academician Oparin St., Moscow, 117997

doctor.i.ivanov@yandex.ruНаучный центр акушерства, гинекологии и перинатологии имени академика В.И. КулаковаРоссияKulakov National Medical Research Center of Obstetrics, Gynecology and PerinatologyRussian Federation20232712202206157163Copyright © Иванов И.А., 20232023Иванов И.А.Ivanov I.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7277

Эндометриоз – одно из наиболее распространенных гинекологических заболеваний, ассоциированных с болевым синдромом, кровотечениями и снижением фертильности. Существующие методы лечения включают хирургическое удаление эндометриоидных гетеротопий и медикаментозную терапию. Эндометриоз является хроническим заболеванием, для которого характерно рецидивирующее течение. Вследствие этого ключевую роль в ведении пациенток играет выбор долгосрочной супрессивной терапии, обладающей высокой эффективностью, переносимостью, благоприятным профилем безопасности, а также способной обеспечить стойкую ремиссию и улучшение качества жизни. В представленном обзоре проведено обобщение имеющихся данных о существующих методах консервативного лечения пациенток, механизмах терапевтического влияния гормональной терапии на эндометриоидные очаги. Проанализированы национальные рекомендации российских и  международных сообществ по  акушерству и  гинекологии по  ведению пациенток с  эндометриозом в  репродуктивном периоде с учетом результатов систематических обзоров, метаанализов и рандомизированных клинических исследований. Традиционно одним из основных методов гормональной терапии является применение комбинированных оральных контрацептивов и прогестагенов, выбор которых является наиболее дискуссионным вопросом и требует четкого представления об их влиянии на различные формы эндометриоза. В обзоре проанализированы сравнительные данные об эффективности, безопасности, побочных эффектах, влиянии на  качество жизни, частоте рецидивирования при монотерапии различными прогестагенами и их комбинациями с эстрогенами, в т. ч. с учетом различного режима дозирования. Представленные сведения позволяют сделать оптимальный выбор тактики ведения в долгосрочной перспективе с высокой степенью приверженности пациенток к терапии, а значит, высокой эффективностью и низкой частотой рецидивирования.

Endometriosis is one of the most common gynecological diseases associated with severe pelvic pain, uterine bleeding, and infertility. Current treatment patterns include endometriosis excision and medical management. Since endometriosis is a  chronic disease with a recurrent clinical course, the crucial role holds a long-term suppressive therapy. It should be characterized by high efficacy, tolerability, a favorable safety profile, as well providing sustained remission and improving the quality of life. The current review summarizes the modern data on conservative management, mechanisms of hormonal therapeutic effects. The national recommendations of Russian and international obstetrics and gynecology societies were analyzed, taking into account the results of systematic reviews, meta-analyses and randomized clinical trials. Combined oral contraceptives and progestogens are considered as first-line hormone therapy. Choosing the proper medication is a controversial issue that requires a comprehensive understanding of its effect on various forms of endometriosis. The review analyzes comparative data on the effectiveness, safety, side effects, impact on the quality of life, the frequency of relapse during various progestogens monotherapy and oral contraceptives, including different dosage regimens. This data allows making an optimal choice of long-term management, with high compliance and efficiency, associated with low recurrence rate.

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The authors declare that there are no conflicts of interest present.