The use of combined oral contraceptives in patients with endometriosis

И. В. Кузнецова
In: Medical alphabet · 2023 · pp. 14–20 · doi:10.33667/2078-5631-2023-3-14-20 · W4362555495
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This review discusses hormonal therapy for endometriosis, focusing on combined oral contraceptives (COCs) and other approved treatments that suppress ovulation and target endometriotic implants based on the disease's estrogen-dependent and progesterone-resistant pathogenesis.

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This narrative review discusses the use of combined oral contraceptives (КОК) as part of hormonal therapy for endometriosis, framing treatment within endocrine pathogenesis involving estrogen dependence and progesterone resistance, alongside downstream effects on apoptosis, oxidative stress, inflammation, and neuroangiogenesis. The review outlines the rationale for suppressing ovulation via inhibition of the hypothalamus–pituitary–ovary axis and describes that certain hormonal agents, including КОК, are officially approved to relieve endometriosis symptoms. A major caveat is that, as a review, it does not provide new patient-level results or quantify comparative efficacy of КОК using a single systematic methodology. This paper is centrally about endometriosis — it specifically reviews combined oral contraceptives in the hormonal management of endometriosis.

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Abstract

Endometriosis is a benign inflammatory hormone-dependent disease characterized by pain and infertility. It seriously affect women’s health., endometriosis is a chronic disease it requires long-term treatment. Currently, hormonal drugs are most widely used for the treatment of endometriosis, which is based on the endocrine mechanisms of its pathogenesis. Key points are estrogen dependence and progesterone resistance, which provide implantation of ectopic endometrial cells, reduce apoptosis and increase oxidative stress, inflammation and neuroangiogenesis. the pain and infertility is explained by hormonal and inflammatory changes, as well as the systemic diseases and psychiatric disorders often associated with endometriosis. Hormonal treatment of endometriosis is aimed at suppressing ovulation through inhibition of the hypothalamic-pituitary-ovarian axis, as well as directly on endometrioid implants. Gonadotropin-releasing hormone (GnRH) agonists and antagonists, progestins, combined oral contraceptives (COCs) are now offcially approved for use to relieve the symptoms of endometriosis. The review provides information on the current possibilities of hormonal therapy for endometriosis, based on an understanding of the pathogenesis of the disease.
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Применение комбинированных оральных контрацептивов у больных эндометриозом https://doi.org/10.33667/2078-5631-2023-3-14-20 Аннотация Эндометриоз – доброкачественное воспалительное гормонозависимое заболевание характеризуется болью и бесплодием, которые серьезно влияют на женское здоровье. Будучи хроническим заболеванием, эндометриоз требует длительного лечения. В настоящее время для терапии эндометриоза наиболее широко используются гормональные препараты, что основано на эндокринных механизмах его патогенеза. Эстрогенная зависимость и резистентность к прогестерону являются ключевыми моментами, обеспечивающими имплантацию эктопических клеток эндометрия, снижение апоптоза и усиление окислительного стресса, воспаления и нейроангиогенеза. Гормональные и воспалительные изменения объясняют боль и бесплодие, а также системные заболевания и психические расстройства, часто сопутствующие эндометриозу. Гормональное лечение эндометриоза направлено на подавление овуляции посредством ингибирования оси гипоталамус-гипофиз-яичник, а также напрямую на эндометриоидные имплантаты. Агонисты и антагонисты гонадотропин-рилизинг гормона (ГнРГ), прогестины, комбинированные оральные контрацептивы (КОК) в настоящее время официально разрешены для использования с целью облегчения симптомов эндометриоза. В обзоре представлена информация о современных возможностях гормональной терапии эндометриоза, основанной на понимании патогенеза заболевания. Об авторе И. В. КузнецоваРоссия Кузнецова Ирина Всеволодовна, д.м.н., проф., зам. ген. директора по научно-исследовательской работе Москва Список литературы 1. Chapron C, Marcellin L, Borghese B, Santulli P. Rethinking mechanisms, diagnosis and management of endometriosis. Nat. Rev. Endocrinol. 2019;15(11):666–682. DOI: 10.1038/s41574–019–0245-z 2. Kavoussi SK, Lim CS, Skinner BD, Lebovic DI, As-Sanie S. New paradigms in the diagnosis and management of endometriosis. Curr. Opin. Obstet. Gynecol. 2016;28(4):267–276. DOI: 10.1097/GCO.0000000000000288. 3. Vannuccini S, Clemenza S, Rossi M, Petraglia F. Hormonal treatments for endometriosis: The endocrine background. Rev. Endocr. Metab. Disord. 2022;23(3):333–355. DOI: 10.1007/s11154–021–09666-w 4. Zondervan KT, Becker CM, Koga K, Missmer SA, Taylor RN, Viganò P. Endometriosis. Nat. Rev. Dis Primers. 2018;4(1):9. DOI: 10.1038/s41572–018–0008–5 5. Shafrir AL, Farland LV, Shah DK, Harris HR, Kvaskoff M, Zondervan K, Missmer SA. Risk for and consequences of endometriosis: A critical epidemiologic review. Best. Pract. Res. Clin. Obstet. Gynaecol. 2018;51:1–15. DOI: 10.1016/j.bpobgyn.2018.06.001 6. Kobayashi H, Imanaka S, Nakamura H, Tsuji A. Understanding the role of epigenomic, genomic and genetic alterations in the development of endometriosis (review). Mol. Med. Rep. 2014 May;9(5):1483–505. DOI: 10.3892/mmr.2014.2057 7. Reis FM, Petraglia F, Taylor RN. Endometriosis: hormone regulation and clinical consequences of chemotaxis and apoptosis. Hum. Reprod. Update. 2013;19(4):406–418. DOI: 10.1093/humupd/dmt010 8. Reis FM, Coutinho LM, Vannuccini S, Batteux F, Chapron C, Petraglia F. Progesterone receptor ligands for the treatment of endometriosis: the mechanisms behind therapeutic success and failure. Hum. Reprod. Update. 2020;26(4):565–585. DOI: 10.1093/humupd/dmaa009 9. Patel BG, Lenk EE, Lebovic DI, Shu Y, Yu J, Taylor RN. Pathogenesis of endometriosis: Interaction between Endocrine and inflammatory pathways. Best Pract. Res Clin. Obstet. Gynaecol. 2018;50:50–60. DOI: 10.1016/j.bpobgyn.2018.01.006 10. Filippi I, Carrarelli P, Luisi S, Batteux F, Chapron C, Naldini A, Petraglia F. Different Expression of Hypoxic and Angiogenic Factors in Human Endometriotic Lesions. Reprod. Sci. 2016;23(4):492–497. DOI: 10.1177/1933719115607978 11. Barbe AM, Berbets AM, Davydenko IS, Koval HD, Yuzko VO, Yuzko OM. Expression and Signifcance of Matrix Metalloproteinase-2 and Matrix Metalloproteinas-9 in Endometriosis. J. Med. Life. 2020;13(3):314–320. DOI: 10.25122/jml-2020–0117 12. Han SJ, O’Malley BW. The dynamics of nuclear receptors and nuclear receptor coregulators in the pathogenesis of endometriosis. Hum. Reprod. Update. 2014;20(4):467–484. DOI: 10.1093/humupd/dmu002 13. Benagiano G, Brosens I, Habiba M. Structural and molecular features of the endomyometrium in endometriosis and adenomyosis. Hum. Reprod. Update. 2014;20(3):386–402. DOI: 10.1093/humupd/dmt052 14. Leyendecker G, Bilgicyildirim A, Inacker M, Stalf T, Huppert P, Mall G. et al. Adenomyosis and endometriosis. Re-visiting their association and further insights into the mechanisms of auto-traumatisation. An MRI study. Arch Gynecol. Obstet. 2015;291(4):917–932. DOI: 10.1007/s00404–014–3437–8 15. Gori M, Luddi A, Belmonte G, Piomboni P, Tosti C, Funghi L. et al. Expression of microtubule associated protein 2 and synaptophysin in endometrium: high levels in deep infltrating endometriosis lesions. Fertil Steril. 2016;105(2):435–443. DOI: 10.1016/j.fertnstert.2015.10.024 16. Guo SW. Fibrogenesis resulting from cyclic bleeding: the Holy Grail of the natural history of ectopic endometrium. Hum Reprod. 2018;33(3):353–356. DOI: 10.1093/humrep/dey015 17. Chamié LP, Ribeiro DMFR, Tiferes DA, Macedo Neto AC, Serafni PC. Atypical Sites of Deeply Infltrative Endometriosis: Clinical Characteristics and Imaging Findings. Radiographics. 2018;38(1):309–328. DOI: 10.1148/rg.2018170093 18. Vannuccini S, Tosti C, Carmona F, Huang SJ, Chapron C, Guo SW, Petraglia F. Pathogenesis of adenomyosis: an update on molecular mechanisms. Reprod Biomed Online. 2017;35(5):592–601. DOI: 10.1016/j.rbmo.2017.06.016 19. Vannuccini S, Petraglia F. Recent advances in understanding and managing adenomyosis. F1000Res. 2019; 8: F1000 Faculty Rev-283. DOI: 10.12688/f1000research.17242.1 20. Nirgianakis K, Ma L, McKinnon B, Mueller MD. Recurrence Patterns after Surgery in Patients with Different Endometriosis Subtypes: A Long-Term Hospital-Based Cohort Study. J. Clin. Med. 2020;9(2):496. DOI: 10.3390/jcm9020496 21. Agarwal SK, Chapron C, Giudice LC, Laufer MR, Leyland N, Missmer SA. et al. Clinical diagnosis of endometriosis: a call to action. Am. J. Obstet. Gynecol. 2019;220(4):354.e1–354.e12. DOI: 10.1016/j.ajog.2018.12.039 22. De Graaff AA, D’Hooghe TM, Dunselman GA, Dirksen CD, Hummelshoj L; WERF EndoCost Consortium; Simoens S. The signifcant effect of endometriosis on physical, mental and social wellbeing: results from an international cross-sectional survey. Hum. Reprod. 2013;28(10):2677–2685. DOI: 10.1093/humrep/det284 23. Brandes I, Kleine-Budde K, Heinze N, Binder S, Klug C, Schippert C. et al. Cross-sectional study for derivation of a cut-off value for identifcation of an early versus delayed diagnosis of endometriosis based on analytical and descriptive research methods. BMC Womens Health. 2022;22(1):521. DOI: 10.1186/s12905–022–02044-x 24. Tanbo T, Fedorcsak P. Endometriosis-associated infertility: aspects of pathophysiological mechanisms and treatment options. Acta. Obstet. Gynecol. Scand. 2017 96(6):659–667. DOI: 10.1111/aogs.13082 25. Fuldeore MJ, Soliman AM. Prevalence and Symptomatic Burden of Diagnosed Endometriosis in the United States: National Estimates from a Cross-Sectional Survey of 59,411 Women. Gynecol. Obstet. Invest. 2017;82(5):453–461. DOI: 10.1159/000452660 26. Peterson CM, Johnstone EB, Hammoud AO, Stanford JB, Varner MW, Kennedy A, et al; ENDO Study Working Group. Risk factors associated with endometriosis: importance of study population for characterizing disease in the ENDO Study. Am. J. Obstet. Gynecol. 2013;208(6):451.e1–11. DOI: 10.1016/j. ajog.2013.02.040 27. Perelló M, Martínez-Zamora MA, Torres X, Munrós J, Llecha S, De Lazzari E, et al. Markers of deep infltrating endometriosis in patients with ovarian endometrioma: a predictive model. Eur. J. Obstet. Gynecol. Reprod. Biol. 2017;209:55–60. DOI: 10.1016/j.ejogrb.2015.11.024 28. Saha R, Marions L, Tornvall P. Validity of self-reported endometriosis and endometriosis-related questions in a Swedish female twin cohort. Fertil. Steril. 2017;107(1):174–178.e2. DOI: 10.1016/j.fertnstert.2016.09.038 29. Ashraf M, Sadatmahalleh SJ, Akhoond MR, Talebi M. Evaluation of Risk Factors Associated with Endometriosis in Infertile Women. Int. J. Fertil. Steril. 2016;10(1):11–21. DOI: 10.22074/ijfs.2016.4763 30. Marinho MCP, Magalhaes TF, Fernandes LFC, Augusto KL, Brilhante AVM, Bezerra LRPS. Quality of Life in Women with Endometriosis: An Integrative Review. J. Womens Health (Larchmt). 2018;27(3):399–408. DOI: 10.1089/jwh.2017.6397 31. Practice Committee of the American Society for Reproductive Medicine. Treatment of pelvic pain associated with endometriosis: a committee opinion. Fertil. Steril. 2014;101(4):927–935. DOI: 10.1016/j.fertnstert.2014.02.012 32. Clemenza S, Sorbi F, Noci I, Capezzuoli T, Turrini I, Carriero C, et al. From pathogenesis to clinical practice: Emerging medical treatments for endometriosis. Best Pract.Res Clin. Obstet. Gynaecol. 2018;51:92–101. DOI: 10.1016/j.bpobgyn.2018.01.021 33. Ceccaroni M, Bounous VE, Clarizia R, Mautone D, Mabrouk M. Recurrent endometriosis: a battle against an unknown enemy. Eur. J. Contracept. Reprod. Health Care. 2019;24(6):464–474. DOI: 10.1080/13625187.2019.1662391 34. Ianieri MM, Mautone D, Ceccaroni M. Recurrence in Deep Infltrating Endometriosis: A Systematic Review of the Literature. J. Minim Invasive Gynecol. 2018;25(5):786–793. DOI: 10.1016/j.jmig.2017.12.025 35. Ferrero S, Barra F, Leone Roberti Maggiore U. Current and Emerging Therapeutics for the Management of Endometriosis. Drugs. 2018;78(10):995–1012. DOI: 10.1007/s40265–018–0928–0 36. Федеральные клинические рекомендации «Эндометриоз». 2020 г. Federal clinical guidelines «Endometriosis». 2020 37. Becker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L. et al. ESHRE Endometriosis Guideline Group. ESHRE guideline: endometriosis. Hum Reprod. Open. 2022;2022(2): hoac009. DOI: 10.1093/hropen/hoac009 38. Capezzuoli T, Vannuccini S, Mautone D, Sorbi F, Chen H, Reis FM. et al. Long-term hormonal treatment reduces repetitive surgery for endometriosis recurrence. Reprod. Biomed Online. 2021;42(2):451–456. DOI: 10.1016/j.rbmo.2020.09.018 39. Barra F, Scala C, Ferrero S. Current understanding on pharmacokinetics, clinical effcacy and safety of progestins for treating pain associated to endometriosis. Expert Opin. Drug Metab. Toxicol. 2018;14(4):399–415. DOI:10.1080/17425255.2018.1461840 40. Оразов М.Р., Орехов Р.Е. Персонификация терапии пациенток, страдающих поверхностным и глубоким инфильтративным эндометриозом // Женская клиника. 2022;1:37–47. 41. Оразов М.Р. «Спасательный круг» для пациенток, страдающих тазовой болью, обусловленной эндометриозом // Женская клиника. 2021;2:6–12. 42. Murji A, Biberoğlu K, Leng J, Mueller MD, Römer T, Vignali M, Yarmolinskaya M. Use of dienogest in endometriosis: a narrative literature review and expert commentary. Curr. Med. Res Opin. 2020;36(5):895–907. DOI: 10.1080/03007995.2020.1744120 43. Chantalat E, Valera MC, Vaysse C, Noirrit E, Rusidze M, Weyl A. et al. Estrogen Receptors and Endometriosis. Int. J. Mol. Sci. 2020;21(8):2815. DOI: 10.3390/ijms21082815 44. Dyson MT, Roqueiro D, Monsivais D, Ercan CM, Pavone ME, Brooks DC. et al. Genome-wide DNA methylation analysis predicts an epigenetic switch for GATA factor expression in endometriosis. PLoS Genet. 2014;10(3): e1004158. DOI: 10.1371/journal.pgen.1004158 45. Sophonsritsuk A, Tantanavipas S, Tingthanatikul Y, Lertvikool S, Dittharot K, Waiyaput W. Effects of Ethinyl Estradiol in Combined Oral Contraceptives on Cell Proliferation and Apoptosis in Ectopic Endometrial Tissue: A Randomized Controlled Study. J. Family. Reprod. Health. 2021;15(1):45–52. 46. Bedaiwy M, Allaire C, Yong P. et al. Medical Management of Endometriosis in Patients with Chronic Pelvic Pain. Semin. Reprod. Med. 2017;35(1):38–53. 47. Koga K, Takamura M, Fujii T, Osuga Y. Prevention of the recurrence of symptom and lesions after conservative surgery for endometriosis. Fertil. Steril. 2015;104(4):793–801. DOI: 10.1016/j.fertnstert.2015.08.026 48. Dunselman GAJ, Vermeulen N, Becker C. et al. ESHRE guideline: management of women with endometriosis. Hum. Reprod. 2014;29(3):400–412. 49. Brown J, Crawford TJ, Datta S, Prentice A. Oral contraceptives for pain associated with endometriosis. Cochrane Database Syst. Rev. 2018;5(5): CD 001019. DOI: 10.1002/14651858.CD001019.pub3 50. Ulrich U, Buchweitz O, Greb R. et al. For the German and Austrian Societies for Obstetrics and Gynecology. National German Guideline (S 2k): Guideline for the Diagnosis and Treatment of Endometriosis: Long Version – AWMF Registry No. 015–045. Geburtshilfe Frauenheilkd 2014;74(12):1104–1118. 51. Caruso S, Iraci M, Cianci S, Fava V, Casella E, Cianci A. Comparative, open-label prospective study on the quality of life and sexual function of women affected by endometriosis-associated pelvic pain on 2 mg dienogest/30 µg ethinyl estradiol continuous or 21/7 regimen oral contraceptive. J. Endocrinol Invest. 2016;39(8):923–931. 52. Zakhari A, Delpero E, McKeown S, Tomlinson G, Bougie O, Murji A. Endometriosis recurrence following post-operative hormonal suppression: a systematic review and meta-analysis. Hum. Reprod. Update. 2021;27(1):96–107. DOI: 10.1093/humupd/dmaa033 53. Becker CM, Gattrell WT, Gude K, Singh SS. Reevaluating response and failure of medical treatment of endometriosis: a systematic review. Fertil. Steril. 2017;108(1):125–136. DOI: 10.1016/j.fertnstert.2017.05.004 54. Caruso S, Iraci M, Cianci S, Vitale SG, Fava V, Cianci A. Effects of long-term treatment with Dienogest on the quality of life and sexual function of women affected by endometriosis-associated pelvic pain. J. Pain. Res. 2019;12:2371–2378. DOI: 10.2147/JPR.S207599 55. Leone Roberti Maggiore U, Remorgida V, Scala C, Taf E, Venturini PL, Ferrero S. Desogestrel-only contraceptive pill versus sequential contraceptive vaginal ring in the treatment of rectovaginal endometriosis infltrating the rectum: a prospective open-label comparative study. Acta. Obstet. Gynecol. Scand. 2014;93(3):239–247. DOI: 10.1111/aogs.12326 56. Morotti M, Remorgida V, Venturini PL, Ferrero S. Progestogen-only contraceptive pill compared with combined oral contraceptive in the treatment of pain symptoms caused by endometriosis in patients with migraine without aura. Eur. J. Obstet. Gyneco.l Reprod. Biol. 2014;179:63–68. DOI: 10.1016/j.ejogrb.2014.05.016 57. Vercellini P, Bracco B, Mosconi P, Roberto A, Alberico D, Dhouha D, Somigliana E. Norethindrone acetate or dienogest for the treatment of symptomatic endometriosis: a before and after study. Fertil Steril. 2016;105(3):734–743.e3. DOI: 10.1016/j.fertnstert.2015.11.016 58. Carr B, Dmowski WP, O’Brien C, Jiang P, Burke J, Jimenez R. et al. Elagolix, an oral GnRH antagonist, versus subcutaneous depot medroxyprogesterone acetate for the treatment of endometriosis: effects on bone mineral density. Reprod. Sci. 2014;21(11):1341–1351. DOI: 10.1177/1933719114549848 59. Taylor HS, Giudice LC, Lessey BA, Abrao MS, Kotarski J, Archer DF, et al. Treatment of Endometriosis-Associated Pain with Elagolix, an Oral GnRH Antagonist. N. Engl.J. Med. 2017;377(1):28–40. DOI: 10.1056/NEJMoa1700089 60. Tsai HW, Wang PH, Huang BS, Twu NF, Yen MS, Chen YJ. Low-dose add-back therapy during postoperative GnRH agonist treatment. Taiwan J Obstet Gynecol. 2016;55(1):55–59. DOI: 10.1016/j.tjog.2015.04.004 61. Priya K, Rajaram S, Goel N. Comparison of combined hormonal vaginal ring and low dose combined oral hormonal pill for the treatment of idiopathic chronic pelvic pain: a randomised trial. Eur J Obstet Gynecol Reprod Biol. 2016;207:141–146. DOI: 10.1016/j.ejogrb.2016.10.026 62. Grandi G, Barra F, Ferrero S, Sileo FG, Bertucci E, Napolitano A, Facchinetti F. Hormonal contraception in women with endometriosis: a systematic review. Eur. J. Contracept. Reprod. Health Care. 2019;24(1):61–70. DOI:10.1080/13625187.2018.1550576 63. Muzii L, Di Tucci C, Achilli C, Di Donato V, Musella A, Palaia I, Panici PB. Continuous versus cyclic oral contraceptives after laparoscopic excision of ovarian endometriomas: a systematic review and metaanalysis. Am J Obstet Gynecol. 2016;214(2):203–211. DOI: 10.1016/j.ajog.2015.08.074 Рецензия Для цитирования: Кузнецова И.В. Применение комбинированных оральных контрацептивов у больных эндометриозом. Медицинский алфавит. 2023;(3):14-20. https://doi.org/10.33667/2078-5631-2023-3-14-20 For citation: Kuznetsova I.V. The use of combined oral contraceptives in patients with endometriosis. Medical alphabet. 2023;(3):14-20. (In Russ.) https://doi.org/10.33667/2078-5631-2023-3-14-20 JATS XML

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