Analysis of the effectiveness of various methods of managing patients with endometriosis and justification for long-term personalized anti-relapse therapy with dydrogesterone as part of their combination treatment strategy

Bezhenar’ V.F.

Pavlov First St. Petersburg State Medical University

ORCID: 0000-0002-7807-4929

Kruglov S.Yu.

First Pavlov State Medical University

ORCID: 0000-0002-8698-7904

Kuzmina N.S.

First Pavlov State Medical University

ORCID: 0000-0002-1675-4144

Constandenkova A.S.

First Pavlov State Medical University

ORCID: 0000-0002-6362-107X

Gramatikova A.G.

First Pavlov State Medical University

ORCID: 0000-0001-7463-1831

Izorkina V.A.

First Pavlov State Medical University

ORCID: 0000-0002-1316-5280

Grigoryan A.E.

First Pavlov State Medical University

ORCID: 0000-0002-1674-7753

Fedosova D.V.

First Pavlov State Medical University

ORCID: 0000-0003-1030-6110

Ismogulova A.B.

First Pavlov State Medical University

ORCID: 0000-0002-7830-8123

Analysis of the effectiveness of various methods of managing patients with endometriosis and justification for long-term personalized anti-relapse therapy with dydrogesterone as part of their combination treatment strategy

Authors:

Bezhenar’ V.F., Kruglov S.Yu., Kuzmina N.S., Constandenkova A.S., Gramatikova A.G., Izorkina V.A., Grigoryan A.E., Fedosova D.V., Ismogulova A.B.

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Journal: Russian Journal of Human Reproduction. 2024;30(2): 102‑111

DOI: 10.17116/repro202430021102

Downloaded: 97

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To cite this article:

Bezhenar’ VF, Kruglov SYu, Kuzmina NS, et al. . Analysis of the effectiveness of various methods of managing patients with endometriosis and justification for long-term personalized anti-relapse therapy with dydrogesterone as part of their combination treatment strategy. Russian Journal of Human Reproduction. 2024;30(2):102‑111. (In Russ.)
https://doi.org/10.17116/repro202430021102

Подписка 2025 (Russian Journal of Human Reproduction)

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PURPOSE

Analysis of endometriosis-associated pain therapy in patients with endometriosis before the surgical stage of endometriosis treatment and anti-relapse therapy with didrogesterone in patients with relapsed endometriosis.

MATERIAL AND METHODS

115 patients aged 19 to 44 years (median age 30.4±3.2 years) with laparoscopically and histologically confirmed endometriosis, progressing against the background of previous surgical and drug treatment, who received hormone therapy with didrogesterone in 3 different regimens in the postoperative period. An analysis of the therapy preceding the recurrence of endometriosis was performed. 12 months after surgery and didrogesterone therapy, the dynamics of a decrease in the intensity of HTB, an improvement in the quality of life and the frequency of pregnancy in patients with infertility were evaluated.

RESEARCH RESULTS

In the study cohort (115 patients), a high recurrence rate of endometriosis was observed in 61 (52%) patients due to the inexpediency of using medicines and low compliance with the therapy. 28 (24%) patients received combined oral contraceptives (COCs) not as indicated, 40 (35%) patients received nonsteroidal anti—inflammatory drugs, 29 (25%) patients received other drugs recommended by specialists of related specialties, 20 (17%) patients did not receive treatment — which contributed to the progression of endometriosis and the need for surgical treatment. The use of combined oral contraceptives (COCs) not as indicated by 9 (14.8%), severe tolerability of a-GnRH therapy in 7 (11.5%) patients, continuous dienogest therapy regimen without taking into account the needs of patient 7 (11.5%), lack of anti-relapse therapy were integral factors in the development of endometriosis recurrence after previously performed surgical treatment. After 12 months of combined treatment of endometriosis (surgical treatment with long-term anti-relapse therapy with didrogesterone), there was a significant decrease in the intensity of symptoms of endometriosis and a high incidence of pregnancy in patients with infertility — 38 (86%) patients.

CONCLUSION

The lack of effective personalized pathogenetic therapy of endometriosis using progestogens causes a high risk of endometriosis progression. The expediency of introducing a unified strategy for personalizing and prescribing hormone therapy in accordance with the algorithms for managing patients with endometriosis has been confirmed. Surgical treatment should be permissible radical, the appointment of long-term anti-relapse hormone therapy for endometriosis after surgical treatment should be mandatory.

Keywords:

endometriosis

chronic pelvic pain

progesterone sensitization

dydrogesterone

dienogest

Authors:

Bezhenar’ V.F.

Pavlov First St. Petersburg State Medical University

ORCID: 0000-0002-7807-4929

Kruglov S.Yu.

First Pavlov State Medical University

ORCID: 0000-0002-8698-7904

Kuzmina N.S.

First Pavlov State Medical University

ORCID: 0000-0002-1675-4144

Constandenkova A.S.

First Pavlov State Medical University

ORCID: 0000-0002-6362-107X

Gramatikova A.G.

First Pavlov State Medical University

ORCID: 0000-0001-7463-1831

Izorkina V.A.

First Pavlov State Medical University

ORCID: 0000-0002-1316-5280

Grigoryan A.E.

First Pavlov State Medical University

ORCID: 0000-0002-1674-7753

Fedosova D.V.

First Pavlov State Medical University

ORCID: 0000-0003-1030-6110

Ismogulova A.B.

First Pavlov State Medical University

ORCID: 0000-0002-7830-8123

Received:

01.03.2024

Accepted:

16.03.2024

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