Endometriosis is a widespread gynecological disease which affects every tenth woman of reproductive age. The main symptoms of disease are chronic pelvic pain, sterility and miscarriage, that leads to a reliable decline in quality of life and working capacity, mental disorders. Timely and complete diagnostics of endometriosis allows choosing the best option of treatment and minimizes the costs of treatment. This article describes in detail the existing methods of diagnosis of endometriosis. Modern literature and the results of own studies are summarized in the text.
Introduction. The chronic, progressive, recurrent nature of the endometriosis results new avenues of targeted therapy for genital endometriosis with high therapeutic efficacy and minimal side effects must be explored. Nowadays, the standard of prolonged specific therapy for endometriosis is the dienogest 2 mg daily, which has already been proven to be effective in vitro, in vivo and in clinical practice. Purpose: to evaluate the effectiveness of new types of targeted pathogenetic therapy for endometriosis on the model of endometriosis in rats compared to dienogest and without treatment. Materials and methods. Endometriosis was induced on 69 Wistar rats by autotransplantation of uterine fragments onto the inner surface of the abdominal wall. After 14 days, the heterotopies had been measured by laparoscopy and then rats were randomized of into one of 6 experimental groups (dienogest, letrozole, cabergoline, metformin, vitamin D, melatonin) or a control group. All drugs were administered daily orally for three weeks, after which an autopsy and re-measuring of the size of endometrial implants were performed. Results. The most pronounced decrease in the size of endometrial implants was observed in the group of animals treated with dienogest (complete resorption - 48%, regression - 48%, without dynamics - 4%) and letrozole (complete resorption - 44%, regression - 56%) without the statistically significant difference between groups. In other groups, a significant decrease in the size of endometrial implants was demonstrated compared with the control, without a statistically significant difference between the groups. Findings. The presented study confirms the absence at the present time of oral drugs for the treatment of endometriosis, comparable in efficacy and safety with dienogest. Further research are needed to evaluate the different combinations of dopamine agonists, biguanides, vitamin D, melatonin as the supplement to the classic hormone-modulating therapy for endometriosis or as monotherapy in patients with contraindications to standard hormone therapy.
According to recent year studies, the classical biguanide metformin has antiproliferative, proapoptotic and anti-inflammatory effects in addition to the main hypoglycemic effect. There are clinical and experimental studies these effects in the therapy of oncological and benign hyperplastic diseases. There is no data about the clinical efficacy of metformin in the therapy of endometriosis in the domestic literature, and there were a few studies in foreign sources. There was a decrease in the severity of the pain syndrome and an increase of pregnancy rate in two clinical studies with small samples. However, future studies are needed to investigate the mechanisms of the target drug effect and to develop effective regimens for the treatment of endometriosis.
Эндометриоз является хроническим мультифакториальным заболеванием, поражающим каждую десятую женщину репродуктивного возраста. Установить точную распространенность эндометриоза сложно из-за многообразия симптомов и инвазивности методов достоверной диагностики. По данным нескольких источников [1, 2], авторы которых использовали разные методологические подходы, эндометриозом страдают приблизительно 5,5 млн женщин в США и Канаде, находящихся в репродуктивном возрасте, а также 16 млн женщин в Европе. Главными симптомами эндометриоза являются бесплодие и хроническая тазовая боль. Хронический болевой синдром ведет к снижению или временной потере трудоспособности, что приводит к серьезным социальным и экономическим последствиям. В последние годы отмечается повышение интереса к изучению влияния эндометриоза на качество жизни. Хроническая природа заболевания создает проблемы во многих аспектах жизни пациентки-профессиональной, социальной и личной сфере, эмоцио
Endometriosis is a chronic inflammatory hormone-dependent disease characterized by abnormal proliferation in the endometrium, nerves, blood vessels, fibroblasts, etc. and accompanied by immunological disorders. Growth factors are an important part of the mechanisms that underlie intercellular communication, auto- and paracrine regulation. This literature review presents data on abnormal expression of growth factors in patients with endometriosis, relationship of growth factors and hormonal status in normal and endometrial tissues, and the supposed role of growth factors in the pathogenesis of the disease.
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