Features of the clinical picture and severity of pain syndrome in girls with genital endometriosis on the background of conservative therapy of the disease in adolescence

Khashchenko E.P. Khashchenko, Margarita Yu. Pustynnikova, S.O. Kyurdzidi, E.V. Uvarovа, I.A. Salnikovа
In: Meditsinskiy sovet = Medical Council · 2023 · pp. 236–246 · doi:10.21518/2079-701x-2022-16-23-236-246 · W4317748911
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A 1-year conservative therapy of NSAIDs and gestagens significantly reduced pain and clinical symptoms in adolescent girls with genital endometriosis, improving their quality of life.

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This prospective longitudinal study evaluated 32 girls aged 14–17 years with confirmed genital endometriosis to characterize their clinical presentation and pain severity over 1 year while receiving conservative therapy with naproxen for dysmenorrhea and dienogest. The primary pain complaint was menstrual- or mid-cycle onset (64%), with additional reports of pain intensifying 1–1.5 years after menarche (23%), reaching very high VAS scores (8.3 ± 1.6) and commonly described as pulling (44%) or cramping (25%), alongside frequent limitations in daily activities (75%) and associated gastrointestinal symptoms (44%) and dysuria (22%). After 12 months, pain intensity during and outside menses, activity limitation, weakness/work impairment during menses, gastrointestinal and urinary symptoms, and the need for mandatory analgesic intake all decreased significantly (p < 0.001 for these outcomes). This paper is centrally about endometriosis — focusing on the clinical picture and severity of pain syndrome in adolescent girls with genital endometriosis undergoing 1-year conservative therapy.

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Abstract

Introduction . Endometriosis is characterised by a chronic course and significantly affects the quality of life of young patients. Aim. To study the features of the clinical picture and pain syndrome in adolescent girls with genital endometriosis against the background of 1 year of therapy. Materials and methods . A prospective longitudinal study included 32 girls (14–17 years old) with a confirmed diagnosis of genital endometriosis. The clinical picture and severity of pain syndrome were assessed against the background of conservative therapy with NSAID (naproxen) to relieve dysmenorrhea and gestagen (dienogest) for 1 year. Results . The main complaint of girls with endometriosis was pain, which appeared on the day before menstruation or in the middle of the cycle since menarche (64%) or increased in 1–1.5 years after menarche (23%) to very intense pain (8.3 ± 1.6 V scale) of a tensive (44%) or clutching (25%) nature. One third of adolescents reported daily pain (24%), the majority (75%) complained of restricted daily activity and performance, gastrointestinal symptoms (44%) and dysuria (22%). After 1 year of treatment with gestagens and NSAIDs patients had a significant decrease in pain on the days of menstruation (p <0,001), as well as outside menstruation (p <0,001), frequency of restriction of daily activities (p <0,001), weakness, lowered working capacity on menstrual days (p < 0.001), gastrointestinal symptoms (p < 0.001) and urinary disorders (p < 0.001) and the need for mandatory pain medication (p < 0.001). Conclusion . A significant reduction in pain syndrome and clinical manifestations of dysmenorrhea against the background of an improved quality of life was observed in the adolescent patients during 1 year of conservative endometriosis therapy. No intensification or increase in the frequency of headache attacks or significant changes in BMI were observed in the study group, which is indicative of good tolerance and contributes to treatment adherence in young female patients.
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Особенности клинической картины и выраженности болевого синдрома у девочек с генитальным эндометриозом на фоне консервативной терапии заболевания в подростковом возрасте https://doi.org/10.21518/2079-701X-2022-16-23-236-246 Аннотация Введение. Эндометриоз характеризуется хроническим течением и значимо влияет на качество жизни молодых пациенток. Цель. Изучить особенности клинической картины и болевого синдрома у девочек-подростков с генитальным эндометриозом на фоне терапии в течение 1 года. Материалы и методы. В проспективное продольное исследование включены 32 девочки (14–17 лет) с подтвержденным диагнозом генитального эндометриоза. Проведена оценка клинической картины и выраженности болевого синдрома на фоне консервативной терапии препаратом НПВС (напроксен) с целью купирования дисменореи и гестагеном (диеногест) в течение 1 года. Результаты. Основной жалобой девочек с эндометриозом являлась боль, появляющаяся у большинства накануне менструации или в середине цикла с менархе (64%) или усилившаяся через 1–1,5 года после менархе (23%) до значений очень интенсивной боли по ВАШ (8,3 ± 1,6 балла) тянущего (44%) или схваткообразного (25%) характера. Треть подростков отмечали ежедневную боль (24%), большинство (75%) – жалобы на ограничение повседневной активности и работоспособности, гастроинтестинальные симптомы (44%) и дизурию (22%). Через 1 год на фоне лечения гестагенами и НПВС у пациенток значимо снизилась выраженность боли в дни менструации (p < 0,001), а также вне менструации (p < 0,001), частота ограничения повседневной активности (p < 0,001), слабости, снижения работоспособности в дни менструации (p < 0,001), гастроинтестинальных симптомов (p < 0,001) и нарушения мочеиспускания (p < 0,001), а также необходимость в обязательном приеме обезболивающих препаратов (р < 0,001). Заключение. На фоне консервативной терапии эндометриоза у пациенток подросткового возраста в течение 1 года отмечено значимое снижение болевого синдрома и клинических проявлений дисменореи на фоне улучшения качества жизни. В изучаемой группе не было отмечено усиления или учащения приступов головной боли, а также значимого изменения ИМТ, что говорит о хорошей переносимости и способствует приверженности к лечению молодых пациенток. Ключевые слова Об авторах Е. П. ХащенкоРоссия Хащенко Елена Петровна – кандидат медицинских наук, врач-гинеколог, старший научный сотрудник 2-го гинекологического отделения (детского и юношеского возраста). 117997, Москва, ул. Академика Опарина, д. 4 М. Ю. Пустынникова Россия Пустынникова Маргарита Юрьевна - студентка факультета фундаментальной медицины. 119991, Москва, ул. Колмогорова, д. 1 С. О. Кюрдзиди Россия Кюрдзиди Станислав Олегович - аспирант кафедры акушерства, гинекологии, перинатологии и репродуктологии Института профессионального образования. 119991, Москва, ул. Трубецкая, д. 8, стр. 2 Е. В. Уварова Россия Уварова Елена Витальевна - член-корреспондент РАН, доктор медицинских наук, профессор кафедры акушерства, гинекологии, перинатологии и репродуктологии Института профессионального образования, ПМГМУ им. И.М. Сеченова (Сеченовский Университет); заведующая 2-м гинекологическим отделением (детского и юношеского возраста), НМИЦ акушерства, гинекологии и перинатологии им. ак. В.И. Кулакова. 119991, Москва, ул. Трубецкая, д. 8, стр. 2; 117997, Москва, ул. Академика Опарина, д. 4 И. А. Сальникова Россия Сальникова Ирина Александровна - научный сотрудник 2-го гинекологического отделения (детского и юношеского возраста). 117997, Москва, ул. Академика Опарина, д. 4 Список литературы 1. Chandra P.S., Ranjan S. Psychosomatic obstetrics and gynecology – a neglected field? 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Mucosal Immunol. 2017;10(5):1097–1107. https://doi.org/10.1038/mi.2017.35. Рецензия Для цитирования: Хащенко ЕП, Пустынникова МЮ, Кюрдзиди СО, Уварова ЕВ, Сальникова ИА. Особенности клинической картины и выраженности болевого синдрома у девочек с генитальным эндометриозом на фоне консервативной терапии заболевания в подростковом возрасте. Медицинский Совет. 2022;(23):236-246. https://doi.org/10.21518/2079-701X-2022-16-23-236-246 For citation: Khashchenko EP, Pustynnikova MY, Kyurdzidi SO, Uvarova EV, Salnikova IA. Features of the clinical picture and severity of pain syndrome in girls with genital endometriosis on the background of conservative therapy of the disease in adolescence. Meditsinskiy sovet = Medical Council. 2022;(23):236-246. (In Russ.) https://doi.org/10.21518/2079-701X-2022-16-23-236-246 JATS XML

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