Modern view on the etiology, pathogenesis and possibilities of diagnostics of external genital endometriosis.

Medvedev, Mikhail V.; Покровенко, Д. А.

doi:10.26641/2307-0404.2019.1.162173

Cited by 5 publications

(2 citation statements)

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“…Генітальний ендометріоз -доброякісне гормонозалежне захворювання, основою якого є наявна гетеротопія ендометрія на тлі порушення функції гіпоталамо-гіпофізарно-яєчникової системи, імунного дисбалансу за генетичної схильності [1][2][3][4].…”

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The role of progestogens in the treatment of endometriosis

Zhylka,

Shcherbinska

2023

RHW

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According to global data the prevalence of endometriosis ranges from 2 to 10% among the general female population and up to 50% among women with infertility. Therefore, at least 190 million women and adolescent girls worldwide have been diagnosed with this disease.Endometriosis, according to evidence, can exhaust a woman physically and emotionally, thereby significantly reducing her quality of life. In particular, pain symptoms affect quality of life and a range of activities and life domains, including physical functioning, daily activities and social life, education and work, sex, intimate relationships and intimate partnerships, and mental health and emotional well-being.This pathology is often accompanied by infertility. Endometriosis has social importance in general, for example due to direct and indirect health care costs comparable to other common diseases such as type 2 diabetes, rheumatoid arthritis and Crohn’s disease.The pathogenesis of endometriosis prompts scientists to search for new methods of conservative treatment. One of the modern means that allow to expand the clinical possibilities of impact on endometriosis is a drug from the dienogest group. The commitment of specialists to the use of dienogest is significantly influenced by the understanding of its pharmacokinetics. After oral use, dienogest is quickly and completely absorbed. The maximum concentration in blood serum is reached within 1.5 hours after a single oral intake and is 47 ng/ml.The bioavailability of dienogest is quite high and is approximately 91%. Its pharmacokinetics are dose-dependent in the dose range of 1–8 mg. Dienogest at a dose of 2 mg/day is an effective alternative to surgery for the long-term treatment of endometriosis, which is well tolerated and has a number of important advantages over combined oral contraceptives. In addition, the available data indicate that patients are ready for possible irregular bleeding, which often occurs with the use of 2 mg of dienogest, since the drug reduces the painful manifestations of endometriosis.In clinical practice, important components of treatment management are counseling patients about expected side effects, evaluating the effectiveness and safety of each therapeutic approach, and following existing recommendations regarding the provision of individual care in accordance with the needs and wishes of each woman. Therefore, dienogest belongs to the standard of treatment of endometriosis, it is included in national and world clinical protocols as a drug of the first line of its treatment.

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The role of progestogens in the treatment of endometriosis

Zhylka,

Shcherbinska

2023

RHW

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“…In one-third of cases, endo-metriomas are presented with bilateral localization, significantly worsening the prognosis of reproductive plans [5,6,7]. Early diagnosis remains a complex and priority issue, as per the International Association for Endometriosis, it is referred to as a "neglected" condition, given that an average of 7-8 years passes from the onset of symptoms to diagnosis [8,9]. However, risk factors contributing to the formation and progression of the disease are nonspecific, and the clinical presentation does not always correspond to the severity of the condition [10].…”

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Medical-Social Audit of Reproductive Age Women With Ovarian Endometriomas

Dyndar,

Dymarska

2024

Med. Sci. of Ukr.

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Background. Ovarian endometriomas account for 35% of all benign ovarian cysts and are identified in 17-44% of women with endometriosis. External genital endometriosis is diagnosed in 10-15% of women in the general population, 25-60% of patients with infertility, 80% of those with pelvic pain syndrome, and in cases of dysmenorrhea, it ranges from 40 to 60%. Priority issues include early diagnosis, management tactics, and preservation of ovarian reserve in women with ovarian endometriomas. However, risk factors contributing to the formation and progression of the disease are nonspecific, and the clinical presentation does not always correspond to the severity of the condition. Aim. To determine the clinical and anamnestic features of women of reproductive age with ovarian endometriomas. Materials and methods. A clinical and anamnestic examination was conducted on 120 reproductive-aged patients with ovarian endometriomas (main group) and 30 women without gynecological pathology (control group). The average age of the examined individuals was 29.5±1.3 years. The examination protocol included the assessment of objective and subjective data recorded in a specially designed questionnaire containing 300 questions. Statistical data analysis was performed using the computer program "Statisticа 13.3.721." Results. The main complaints of examined women with ovarian endometriomas include a dragging pain in the lower abdomen (82.5%), menstrual cycle disturbances (95.8%), dyspareunia (26.7%), impairment of adjacent organ functions (10.8%), periovulatory pain (12.5%), primary (30.8%), and secondary (19.2%) infertility. Early menarche was found in 48.3% of women, and late menarche in 15.8%. Dysmenorrhea was observed in 86.7%, hypermenorrhea in 73.3%, and acyclic bloody discharges in 12.5%. From the gynecological history, there is a 3.8 times higher frequency of inflammatory diseases of the appendages, a 4.1 times higher frequency of breast diseases, a 2.4 times higher frequency of abnormal uterine bleeding, a 2.3 times higher frequency of "functional" ovarian cysts and ovarian apoplexy. Endometriomas in 13.3% of patients were combined with adenomyosis, in 14.2% with uterine fibroids, and in 10.8% with intrauterine pathology. Conclusion. The analysis of clinical and anamnestic data of women with ovarian endometriomas revealed the main complaints at the time of admission to the hospital, previous and concomitant extragenital pathology, identified the family history, status of menstrual and reproductive function, and gynecological diseases.

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Peculiarities of the clinical course and pathomorphological picture of ovarian endometriosis and adenomyosis in reproductive aged women

Hladchuk

Рожковська

Sytnikova

et al. 2022

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Оbjectives: to assess the clinical and pathomorphological features of ovarian endometriosis and adenomyosis in women of reproductive age in order to determine possible causes of fertility disorders and ways to correct them.Materials and methods. 87 patients were examined and divided into 2 groups. The first group included 45 (51.7%) patients with adenomyosis with or without concomitant pathology. The second group included 42 (48.3%) women with ovarian endometriomas. The control group consisted of 30 healthy women of childbearing age who were screened for male infertility.Results. Clinical examination of the patients revealed a high frequency of gynecological (uterine fibroids, endometrial hyperplasia, infertility) and extragenital pathology. Obstetric and gynecological history was burdened by reproductive losses (involuntary and medical abortions, ectopic pregnancy), premature birth, preeclampsia, abnormal uterine and obstetric bleeding, and pelvic surgery. All patients underwent endoscopic treatment (laparoscopy, hysteroscopy). Morphological examination revealed features of the structure of endometrioid cysts, which explains the decrease in ovarian reserve, active adenomyosis, reactive hyperplasia and chronic endometritis, distortion of the uterine cavity by fibroids. This may play an important role in implantation and placentation.Conclusions. Features of morphogenesis of ovarian endometrioma, found by us cystic and glandular-cystic forms may form the basis of endometrial microperforation pathogenesis, development of adhesions of the pelvic organs (in every third woman), ectopic pregnancy, fibrotic adjacent endometrioid tissue and reduction of ovarian reserve. The peculiarities of the uterus histostructure in adenomyosis, frequent combination with uterine fibroids, endometrial hyperplasia, chronic endometritis, ovarian endometriosis, deep infiltrative endometriosis, old age, aggravated obstetric anamnesis and the history of obstetric disorders may be related.

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Modern view on the etiology, pathogenesis and possibilities of diagnostics of external genital endometriosis.

Cited by 5 publications

References 45 publications

The role of progestogens in the treatment of endometriosis

The role of progestogens in the treatment of endometriosis

Medical-Social Audit of Reproductive Age Women With Ovarian Endometriomas

Peculiarities of the clinical course and pathomorphological picture of ovarian endometriosis and adenomyosis in reproductive aged women

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