The issues of endometriosis hormonal treatment in reproductive age women

Abstract

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.