Pathogenetic therapy of endometriosis: Updated data on the use of buserelin acetate (depot form)

Endometriosis is a chronic estrogen-dependent disease characterized by ectopic implantation of functional tissue lining the uterus (endometrial glands and stroma) outside its cavity. The term “endometriosis” comes from the Greek words endo – “inside”, metra – “uterus”, and the suffix osis – “disease”. Most often, endometrial tissue is found in the ovaries, which leads to the formation of “chocolate” cysts. Endometrioid heterotopias can be found in the fallopian tubes, uterosacral ligaments, gastrointestinal tract and, less commonly, in the pleura, pericardium or central nervous system. Endometriosis is a common gynecological disease (10% of women of reproductive age) and is accompanied by the development of dyspareunia, dysmenorrhea and infertility. The complexity of the molecular and cellular mechanisms of the disease development makes it difficult to fully understand it and develop effective therapeutic strategies. Although hormones are recommended as first-line therapy, their efficacy and side effects vary significantly in the populations studied. Modern hormonal drugs correct the activity of endometriosis mainly by suppressing the production of estrogens and their systemic effects. The effect of hormonal substances directly on endometrioid heterotopias has not yet been fully established. Data on the activation of transcriptional coregulators, the expression of hormonal receptors in pathological foci and their ability to respond to appropriate stimuli are contradictory and form differentiated therapeutic outcomes in patients. Determining the optimally effective therapeutic tactics remains the main goal in endometriosis research. Gonadotropin-releasing hormone agonists (GnRH agonists) are widely used to treat hormone-dependent gynecological diseases. The multifaceted effect of GnRH agonists on the pathogenetic links of endometriosis (reduced estrogen synthesis, suppression of abnormal proliferation, active neoangiogenesis and inflammation) allows to stop the progression of the disease and quickly block the pain symptom, and the long-term preservation of the effect after the end of treatment helps to reduce the frequency of recurrence of endometrioid lesions. A sufficient evidence base has been accumulated, allowing for the confident use of GnRH agonist therapy to correct the activity of endometriosis. However, periodic updating of this database is a mandatory practice, since the results of new studies may change the conclusions of previous ones. This article presents a review of current data on the efficacy of buserelin acetate (Buserelin-depo, 3.75 mg).

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