Endometriose: evolução das terapias e intervenções cirúrgicas modernas

José Amarildo Avanci Júnior, Marcelo Fontes da Silva, Angelina da Costa Moreno, Pedro Masao Koshiyama, Davi Siqueira, Victor Hugo Patrocinio, Maria Eduarda Prazeres Faccin, Valeria Rampazzo Ribeiro, Valéria Rampazzo Ribeiro, Randolph Miguel Machado Salazar, Giovana Bondavalli Girotto, Maria Gabriela Zachini Parise, Steffani Welter dos Santos
In: Cuadernos de Educación y Desarrollo · 2024 · vol. 16(8) , pp. e5064 · doi:10.55905/cuadv16n8-020 · W4401420106
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This integrative literature review analyzed pharmacological therapies and modern surgical interventions for endometriosis, finding hormonal treatments reduce symptoms but have side effects and recurrence, while laparoscopy improves fertility but also faces recurrence challenges.

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Este artigo realiza uma revisão integrativa da literatura sobre a eficácia de terapias farmacológicas e de intervenções cirúrgicas modernas no tratamento da endometriose, avaliando impacto na qualidade de vida, além de custos e acessibilidade, com busca em PubMed, LILACS e Scopus usando operadores booleanos. Os autores relatam que terapias hormonais, como agonistas do GnRH e contraceptivos orais combinados, reduzem sintomas, mas trazem efeitos colaterais relevantes e taxas de recorrência elevadas, enquanto a cirurgia—especialmente a laparoscopia—beneficia a remoção de lesões e pode melhorar desfechos de fertilidade, embora a recorrência pós-operatória permaneça como desafio. Como ressalva, por ser uma revisão integrativa, o estudo depende da qualidade e da heterogeneidade dos trabalhos incluídos, o que pode limitar a força das conclusões sobre eficácia comparativa. Este paper is centrally about endometriosis — evolução das terapias e intervenções cirúrgicas modernas no tratamento.

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Abstract

A endometriose é uma condição ginecológica crônica caracterizada pela presença de tecido endometrial fora da cavidade uterina, afetando milhões de mulheres em idade reprodutiva globalmente. Este estudo revisa a eficácia das terapias farmacológicas e das intervenções cirúrgicas modernas no tratamento da endometriose, analisando seu impacto na qualidade de vida das pacientes, bem como os custos e a acessibilidade desses tratamentos. A metodologia envolveu uma Revisão Integrativa da Literatura, utilizando operadores booleanos para buscar dados em bases como PubMed, LILACS e Scopus. Os resultados indicam que as terapias hormonais, como os agonistas do GnRH e os contraceptivos orais combinados, são eficazes na redução dos sintomas, mas estão associadas a efeitos colaterais significativos e alta taxa de recorrência. As intervenções cirúrgicas, especialmente a laparoscopia, mostram benefícios na remoção de lesões endometrióticas e na melhora das taxas de fertilidade, embora a recorrência pós-cirúrgica continue sendo um desafio. O desenvolvimento de terapias biológicas e o uso de fitoterápicos emergem como promissoras alternativas terapêuticas, necessitando de mais pesquisas para validar sua eficácia e segurança.
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Endometriose: evolução das terapias e intervenções cirúrgicas modernas DOI: https://doi.org/10.55905/cuadv16n8-020Palavras-chave: dor pélvica, infertilidade, terapias combinadas, medicina de precisãoResumo A endometriose é uma condição ginecológica crônica caracterizada pela presença de tecido endometrial fora da cavidade uterina, afetando milhões de mulheres em idade reprodutiva globalmente. Este estudo revisa a eficácia das terapias farmacológicas e das intervenções cirúrgicas modernas no tratamento da endometriose, analisando seu impacto na qualidade de vida das pacientes, bem como os custos e a acessibilidade desses tratamentos. A metodologia envolveu uma Revisão Integrativa da Literatura, utilizando operadores booleanos para buscar dados em bases como PubMed, LILACS e Scopus. Os resultados indicam que as terapias hormonais, como os agonistas do GnRH e os contraceptivos orais combinados, são eficazes na redução dos sintomas, mas estão associadas a efeitos colaterais significativos e alta taxa de recorrência. As intervenções cirúrgicas, especialmente a laparoscopia, mostram benefícios na remoção de lesões endometrióticas e na melhora das taxas de fertilidade, embora a recorrência pós-cirúrgica continue sendo um desafio. O desenvolvimento de terapias biológicas e o uso de fitoterápicos emergem como promissoras alternativas terapêuticas, necessitando de mais pesquisas para validar sua eficácia e segurança. Referências ABRAMIUK, M. et al. The Role of the Immune System in the Development of Endometriosis. Cells, v. 11, n. 13, p. 2028, 2022. DOI: https://doi.org/10.3390/cells11132028 ALEXANDER, P. et al. Benefits of Surgical Intervention in Women with Endometriosis-Related Infertility. Endometriosis, v. 5, 2020. DOI: https://doi.org/10.5772/intechopen.91820 ALLAIRE, C.; BEDAIWY, M. A.; YONG, P. J. Diagnosis and management of endometriosis. CMAJ, v. 195, n. 10, p. 363-371, 2023. DOI: https://doi.org/10.1503/cmaj.220637 BAFORT, C. et al. Laparoscopic surgery for endometriosis. Cochrane Database Syst Ver, v. 10, n. 10, 2020. DOI: https://doi.org/10.1002/14651858.CD011031.pub3 BEDAIWY, M. A. et al. New developments in the medical treatment of endometriosis. Fertility and Sterility, v. 107, n. 3, p. 555-565, 2017. DOI: https://doi.org/10.1016/j.fertnstert.2016.12.025 BRICHANT, G. et al. New Therapeutics in Endometriosis: A Review of Hormonal, Non-Hormonal, and Non-Coding RNA Treatments. Int J Mol Sci, v. 22, n. 19, 2021. DOI: https://doi.org/10.3390/ijms221910498 BROWN, J. et al. Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis. Cochrane Database Syst Ver, v. 1, n. 1, 2017. DOI: https://doi.org/10.1002/14651858.CD004753.pub4 CANO-HERRERA, G. et al. Endometriosis: A Comprehensive Analysis of the Pathophysiology, Treatment, and Nutritional Aspects, and Its Repercussions on the Quality of Life of Patients. Biomedicines, v. 12, n. 7, p. 1476, 2024. DOI: https://doi.org/10.3390/biomedicines12071476 CAPEZZUOLI, T. et al. Long-term hormonal treatment reduces repetitive surgery for endometriosis recurrence. Reprod Biomed Online, v. 42, n. 2, p. 451-456, 2021. DOI: https://doi.org/10.1016/j.rbmo.2020.09.018 CARRILLO TORRES, P. et al. Clinical and sonographic impact of oral contraception in patients with deep endometriosis and adenomyosis at 2 years of follow-up. Sci Rep, v. 13, n. 1, 2023. DOI: https://doi.org/10.1038/s41598-023-29227-2 COSTA PINHEIRO, D. J. P. et al. Tolerability of endometriosis medical treatment: a comparison between combined hormonal contraceptives and progestins. BMC Womens Health, v. 23, n. 1, p. 510, 2023. DOI: https://doi.org/10.1186/s12905-023-02647-y CUSCHIERI, S. The STROBE guidelines. Saudi J Anaesth, v. 13, n. 1, p. 31-34, 2019. DOI: https://doi.org/10.4103/sja.SJA_543_18 DANIILIDIS, A. et al. Endometriosis and Infertility: What Is the Impact of Surgery? J Clin Med, v. 11, n. 22, p. 6727, 2022. DOI: https://doi.org/10.3390/jcm11226727 DONNEZ, J.; DOLMANS, M. M. Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review. J. Clin. Med, v. 10, n. 5, 2021. DOI: https://doi.org/10.3390/jcm10051085 EL-MALAH, A. A. et al. Selective COX-2 Inhibitors: Road from Success to Controversy and the Quest for Repurposing. Pharmaceuticals, v. 15, n. 7, 2022. DOI: https://doi.org/10.3390/ph15070827 JADAD, A. R. et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, v. 17, n. 1, p. 1-12, 1996. DOI: https://doi.org/10.1016/0197-2456(95)00134-4 KALAITZOPOULOS, D. R. et al. Treatment of endometriosis: a review with comparison of 8 guidelines. BMC Womens Health, v. 21, n. 1, p. 397, 2021. DOI: https://doi.org/10.1186/s12905-021-01545-5 KORDE, L. A. et al. Neoadjuvant Chemotherapy, Endocrine Therapy, and Targeted Therapy for Breast Cancer: ASCO Guideline. Journal of Clinical Oncology, v. 39, n. 13, 2021. DOI: https://doi.org/10.1200/JCO.20.03399 LAGANÀ, A. S. et al. The Pathogenesis of Endometriosis: Molecular and Cell Biology Insights. Int J Mol Sci, v. 20, n. 22, p. 5615, 2019. DOI: https://doi.org/10.3390/ijms20225615 LAMCEVA, J.; ULJANOVS, R.; STRUMFA, I. The Main Theories on the Pathogenesis of Endometriosis. Int J Mol Sci, v. 24, n. 5, p. 4254, 2023. DOI: https://doi.org/10.3390/ijms24054254 LEYLAND, N. et al. A Clinician's Guide to the Treatment of Endometriosis with Elagolix. J Womens Health, v. 4, p. 569-578, 2021. DOI: https://doi.org/10.1089/jwh.2019.8096 LIANG, Y. et al. First-line surgery versus first-line assisted reproductive technology for women with deep infiltrating endometriosis: a systematic review and meta-analysis. Front. Endocrinol, v. 15, 2024. DOI: https://doi.org/10.3389/fendo.2024.1352770 MEHDIZADEHKASHI, A. et al. Does laparoscopic treatment of deep endometriosis improve sexual dysfunction. Caspian J Intern Med, v. 14, n. 2, p. 349-355, 2023. MINALT, N.; CANELA, C. D.; MARINO, S. Endometrial Ablation. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. MORI, T. et al. Local estrogen formation and its regulation in endometriosis. Reprod Med Biol, v. 18, n. 4, p. 305-311, 2019. DOI: https://doi.org/10.1002/rmb2.12285 NEW, E. P.; MIKHAIL, E. A narrative review of using GnRH analogues to reduce endometriosis recurrence after surgery: a double-edged sword. Gynecology and Pelvic Medicine, v. 4, 2021. DOI: https://doi.org/10.21037/gpm-2020-mtet-03 OALĂ, I. E. et al. Endometriosis and the Role of Pro-Inflammatory and Anti-Inflammatory Cytokines in Pathophysiology: A Narrative Review of the Literature. Diagnostics, v. 14, n. 3, p. 312, 2024. DOI: https://doi.org/10.3390/diagnostics14030312 OLADOSU, F. A.; TU, F. F.; HELLMAN, K. M. Nonsteroidal antiinflammatory drug resistance in dysmenorrhea: epidemiology, causes, and treatment. Am J Obstet Gynecol, v. 218, n. 4, p. 390-400, 2018. DOI: https://doi.org/10.1016/j.ajog.2017.08.108 OLIVEIRA, M. A. P. et al. Surgical Treatment of Adenomyosis. Current Obstetrics and Gynecology Reports, v. 11, p. 180-185, 2022. DOI: https://doi.org/10.1007/s13669-022-00335-6 ORGANIZAÇÃO MUNDIAL DA SAÚDE – OMS. Endometriosis. 2023. Disponível em: https://www.who.int/news-room/fact-sheets/detail/endometriosis. PARK, H. J. et al. Could surgical management improve the IVF outcomes in infertile women with endometrioma?: a review. Obstet Gynecol Sci, v. 62, n. 1, p. 1-10, 2019. DOI: https://doi.org/10.5468/ogs.2019.62.1.1 PURGATO, M, et al. Primary-level and community worker interventions for the prevention of mental disorders and the promotion of well-being in low- and middle-income countries. Cochrane Database Syst Ver, v. 10, n. 10, 2023. DOI: https://doi.org/10.1002/14651858.CD014722.pub2 RANGI, A. et al. Fertility Preservation in Women with Endometriosis. J. Clin. Med, v. 12, n. 13, 2023. DOI: https://doi.org/10.3390/jcm12134331 RESTA, C. et al. Gonadotropin-Releasing Hormone (GnRH)/GnRH Receptors and Their Role in the Treatment of Endometriosis. Cureus, v. 15, n. 4, e38136, 2023. DOI: https://doi.org/10.7759/cureus.38136 SHI, J. et al. Research advances in drug therapy of endometriosis Updated. Front. Pharmacol, v. 14, 2023. DOI: https://doi.org/10.3389/fphar.2023.1199010 SMOLARZ, B.; SZYŁŁO, K.; ROMANOWICZ, H. Endometriosis: Epidemiology, Classification, Pathogenesis, Treatment and Genetics (Review of Literature). Int J Mol Sci, v. 22, n. 19, 2021. DOI: https://doi.org/10.3390/ijms221910554 TASSINARI, V. et al. Endometriosis Treatment: Role of Natural Polyphenols as Anti-Inflammatory Agents. Nutrients, v. 15, n. 13, p. 2967, 2023. DOI: https://doi.org/10.3390/nu15132967 THEKEN, K. N. et al. Variability in the Analgesic Response to Ibuprofen Is Associated With Cyclooxygenase Activation in Inflammatory Pain. Clin Pharmacol Ther, v. 106, n. 3, p. 632-641, 2019. DOI: https://doi.org/10.1002/cpt.1446 TOSTI, C. et al. Hormonal therapy for endometriosis: from molecular research to bedside. European Journal of Obstetrics & Gynecology and Reproductive Biology, v. 209, p. 61-66, 2017. DOI: https://doi.org/10.1016/j.ejogrb.2016.05.032 TROÌA, L.; LUISI, S. Estro-Progestins and Pain Relief in Endometriosis. Endocrines, v. 3, n. 2, p. 349-366, 2022. DOI: https://doi.org/10.3390/endocrines3020028 WANG, H. et al. Advancing herbal medicine: enhancing product quality and safety through robust quality control practices. Front Pharmacol, v. 14, 2023. DOI: https://doi.org/10.3389/fphar.2023.1265178 WORTMAN, M. Late-onset endometrial ablation failure. Case Reports in Women's Health, v. 15, p. 11-28, 2017. DOI: https://doi.org/10.1016/j.crwh.2017.07.001 ZAKHARI, A. et al. Endometriosis recurrence following post-operative hormonal suppression: a systematic review and meta-analysis. Hum Reprod Update, v. 27, n. 1, p. 96-107, 2021. DOI: https://doi.org/10.1093/humupd/dmaa033 ZANELOTTI, A.; DECHERNEY, A. H. Surgery and Endometriosis. Clin Obstet Gynecol, v. 60, n. 3, p. 477-484, 2017. DOI: https://doi.org/10.1097/GRF.0000000000000291

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