The issues of endometriosis hormonal treatment in reproductive age women

Тактика выбора гормональной терапии при эндометриозе у пациенток репродуктивного возраста https://doi.org/10.21518/ms2022-001 Аннотация Эндометриоз – одно из наиболее распространенных гинекологических заболеваний, ассоциированных с болевым синдромом, кровотечениями и снижением фертильности. Существующие методы лечения включают хирургическое удаление эндометриоидных гетеротопий и медикаментозную терапию. Эндометриоз является хроническим заболеванием, для которого характерно рецидивирующее течение. Вследствие этого ключевую роль в ведении пациенток играет выбор долгосрочной супрессивной терапии, обладающей высокой эффективностью, переносимостью, благоприятным профилем безопасности, а также способной обеспечить стойкую ремиссию и улучшение качества жизни. В представленном обзоре проведено обобщение имеющихся данных о существующих методах консервативного лечения пациенток, механизмах терапевтического влияния гормональной терапии на эндометриоидные очаги. Проанализированы национальные рекомендации российских и международных сообществ по акушерству и гинекологии по ведению пациенток с эндометриозом в репродуктивном периоде с учетом результатов систематических обзоров, метаанализов и рандомизированных клинических исследований. Традиционно одним из основных методов гормональной терапии является применение комбинированных оральных контрацептивов и прогестагенов, выбор которых является наиболее дискуссионным вопросом и требует четкого представления об их влиянии на различные формы эндометриоза. В обзоре проанализированы сравнительные данные об эффективности, безопасности, побочных эффектах, влиянии на качество жизни, частоте рецидивирования при монотерапии различными прогестагенами и их комбинациями с эстрогенами, в т. ч. с учетом различного режима дозирования. Представленные сведения позволяют сделать оптимальный выбор тактики ведения в долгосрочной перспективе с высокой степенью приверженности пациенток к терапии, а значит, высокой эффективностью и низкой частотой рецидивирования. Ключевые слова Об авторе И. А. ИвановРоссия Иванов Илья Андреевич, к.м.н., научный сотрудник 117997, Москва, ул. Академика Опарина, д. 4 Список литературы 1. Agarwal S.K., Chapron C., Giudice L.C., Laufer M.R., Leyland N., Missmer S.A. et al. Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol. 2019; 220(4):354.e1-354.e12. https://doi.org/10.1016/j.ajog.2018.12.039. 2. Zondervan K.T., Becker C.M., Missmer S.A. Endometriosis. N Engl J Med. 2020; 382(13):1244–1256. https://doi.org/10.1056/NEJMra1810764. 3. Bellelis P., Dias Jr J.A., Podgaec S., Gonzales M., Baracat E.C., Abrão M.S. Aspectos epidemiológicos e clínicos da endometriose pélvica: uma série de casos. 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Nat Rev Endocrinol. 2019;15(11):666–682. https://doi.org/10.1038/s41574-019-0245-z. Рецензия Для цитирования: Иванов ИА. Тактика выбора гормональной терапии при эндометриозе у пациенток репродуктивного возраста. Медицинский Совет. 2023;(6):157-163. https://doi.org/10.21518/ms2022-001 For citation: Ivanov IA. The issues of endometriosis hormonal treatment in reproductive age women. Meditsinskiy sovet = Medical Council. 2023;(6):157-163. (In Russ.) https://doi.org/10.21518/ms2022-001 JATS XML