Oral contraceptives for endometriosis: necessary or not? Choosing birth control pills for endometriosis: which drug is more effective? Is it necessary to take hormonal pills for endometriosis?

Content

Proper treatment of endometriosis by an experienced doctor will allow a woman to get rid of a dangerous disease and restore the normal functioning of the uterus and appendages. An unpleasant disease can cause infertility and develops in 80% of cases during childbearing age in patients who have not reached menopause. Find out whether endometriosis can be cured permanently and what types of therapy are practiced.

What is endometriosis

Before treatment, you need to understand the specifics of the gynecological disease. The human uterus consists of a body, cervix and tubes, and is lined inside with a special layer - the endometrium. Its main function is reproductive. During pregnancy, tissue grows on the inner surface of the uterus, the egg penetrates the thickness of the mucous membrane and attaches. Vessels appear that, with the help of the placenta, ensure the vital activity of the fetus. If pregnancy does not occur, the mucous surface of the uterus peels off and comes out with blood, that is, the woman begins her period.

The disease can occur when blood from the uterine cavity enters other pelvic organs. Endometriosis is a pathological process of growth of the endometrium. There are two forms of the disease;

Genital endometriosis – affects the uterus, ovaries, vagina, and cervix. Occurs in 85% of cases.
Extra-genital endometriosis - postoperative scars, intestines, bladder, and internal organs are affected. A rare form, it occurs due to the fact that blood clots can enter the abdominal cavity. Normally, they should resolve, but it happens that endometrial cells take root outside the uterus and begin to grow. The probability of this form of the disease is 5-15%. Treatment can only occur surgically.

Endometriosis causes internal inflammation in the abdominal cavity. Changes in the structure of organs lead to disruptions in their functioning. Very often this disease is confused with fibroids. Endometriosis leads to damage to the surface of the uterus, the appearance of nodes and adhesions, which can lead to the inability of the embryo to attach, i.e. causes infertility. Modern gynecology has not studied all the causes of the pathological disease. The most likely ones are immune and hormonal disorders, hereditary factors, nervous disorders, and stress.

Symptoms of endometriosis

An insidious disease is fraught with the appearance of symptoms only at a late stage. The patient may suffer from the disease for a long time without even knowing about it. Symptoms of endometriosis:

Enlargement of the uterus up to 5-6 weeks of pregnancy. It takes on a round shape.
Feeling of heaviness in the lower abdomen.
Stomach ache. They can occur during menstruation, sex, defecation and urination.
Infertility.
Menstrual irregularities (occurrence earlier or later than scheduled). The discharge becomes abundant and changes color.

How quickly does endometriosis develop?

Depending on environmental factors, genetic predisposition, age, endometriosis develops differently in each woman. With good immunity, the cells of the uterine mucosa will not take root in another environment or it will take a long time. With a difficult birth, hormonal imbalances, endometriosis may take less than 6 months to develop. A gynecologist will be able to accurately diagnose, treat the disease and monitor the occurrence of relapses. An experienced doctor will prescribe the following methods for diagnosing endometriosis:

Examination and palpation on a gynecological chair. The doctor may notice an enlarged size of the uterus and appendages.
Ultrasound is effective only in the last stages of the disease, when lesions can be clearly seen. It can be used to identify cysts.
Laparoscopy. The painless procedure will allow you to examine the endometrium, pelvic organs, and pathological formations through a small hole.

How to treat endometriosis

Treatment for endometriosis is selected individually depending on the form of the patient’s disease. The conservative method is used in women of childbearing age. It includes taking medications (hormonal painkillers, anti-inflammatory drugs). If the patient’s condition does not improve, surgical treatment is used. The operation is performed in cases of large blood loss, adhesions, and pain. You can find out more about how to treat uterine endometriosis with medication or surgery from your doctor.

Treatment of endometriosis with drugs

For a young woman, it is important to preserve reproductive function, so treatment of endometriosis with drugs is used for the age category of 25-45 years. An integrated approach and various schemes make it possible to get a good effect in a short period of time. In addition to hormonal drugs, symptomatic therapy is used. Treatment consists of relieving pain, nausea, and spasms.

Hormonal drugs

Tablets for endometriosis make it possible to control the duration of the menstrual cycle, and as a result, the growth of the endometrium. Drugs are prescribed for the treatment of endometriosis after a thorough analysis of hormonal levels. When used correctly, they will not cause negative effects. The doctor selects the duration of administration and dose individually. Hormonal drugs for endometriosis:

Single-phase COCs (combined oral contraceptives). These include Janine, Femoden, Logest, Regulon.
Preparations containing one gestagenic component - Progesterone, Duphaston, Utrozhestan. This treatment helps restore reproductive function.
Levonorgestrel-based intrauterine devices. Mirena is popular; it is placed for different periods (from 3 to 7 years).
Preparations containing male hormones androgens (Methyltestosterone).
Gonadotropic drugs (Danol, Danazol). With this treatment, the body's production of its own sex hormones is suppressed.

Treatment regimen for endometriosis

The correct treatment regimen for endometriosis is the one prescribed by your gynecologist after a comprehensive examination. The doctor selects all remedies individually, especially when it comes to hormones. The regimen includes not only taking tablets and injections according to the prescribed course, but also washing, douching, special tampons, compresses, and traditional methods. These methods can allow a woman to get rid of the problem. On average, treatment will last from 6 to 9 months.

Tampons for endometriosis

Tampons are used in gynecology for endometriosis. They are especially effective when the disease affects the cervix and vagina. Tampons are factory-made, impregnated with herbal extracts, hyaluronic acid, and lactic acid. Their action is aimed at restoring functionality and reducing the pain of sexual intercourse. You can also make tampons yourself. To do this, take a roll of cotton wool and a sterile bandage, fold it into 6-8 layers. Soak well in oil or infusion. Leave the tampon in the vagina overnight. The course of treatment is 5-6 weeks.

Douching

The use of douching for endometriosis can be prescribed by a doctor to reduce the growth of the endometrium in the uterus and beyond, and reduce inflammatory processes. Treatment is carried out using a syringe for irrigation or a regular syringe with a soft tip. Pharmaceutical preparations (powders, ready-made solutions: Tantum Rose, Furacilin) and decoctions of medicinal herbs are used for endometriosis.

Surgery

A radical method of treatment is surgery. It is prescribed after a thorough examination. To preserve the possibility of reproductive function, laparoscopy is widely used. Surgical treatment of endometriosis with this method is minimally invasive, involves rapid removal of endometrial tissue and has a good cosmetic effect. The surgery involves small incisions through which the doctor can remove lesions in the uterus and other organs. Or curettage is performed according to the mechanics of abortion.

How to cure endometriosis with folk remedies

Doctors can tell you how to cure endometriosis with folk remedies. Women are afraid to use hormonal drugs, fearing side effects; herbs, animal products and beekeeping come to the rescue. Find out how to treat uterine endometriosis at home from your doctor using simple recipes. Combining different methods gives excellent results and prevents relapses.

Herbal treatment

Treatment of endometriosis with herbs, proven over the years, gives a lasting effect. Many herbal medications are taken for gynecological disorders. The remedy from boron uterus and red brush is taken orally in the form of herbs or alcohol-based drops. Collections with elderberry, raspberry and blackberry leaves help prevent the growth of the endometrium in the uterine cavity.

Nettle

The unique properties of nettle - cleansing the blood of toxins and restoring hormonal disorders - have been known for a long time. The herb can be taken internally and externally (douching, tampons). Nettle for endometriosis relieves pain and reduces the amount of discharge. Treat only with freshly prepared decoction. To do this, pour 2 tablespoons of nettle with a glass of boiling water and leave for half an hour.

Celandine

The beautiful celandine plant is a natural bactericidal and fungicidal healer. It can inhibit tumors in the human body. Celandine should be used with caution for endometriosis. If the specified dosage is exceeded, the patient may develop side effects. Recipes with celandine:

Internal infusion, use 50 ml 3 times a day for 7-14 days. To prepare it, you need to brew 15 g of celandine herb in a glass of boiling water. Let it brew for about 2 hours in a thermos.
The infusion for douching is used 2 times a day for 45-65 days. To prepare it, take 20 g of herb and pour ¾ cup of boiling water. Strain the resulting liquid to remove solid particles.

Treatment with propolis

When traditional and medicinal methods do not help, treatment of endometriosis with propolis gives a good effect. The unique composition of this beekeeping product helps slow down the proliferation of epithelium. Any use of it is effective: tinctures, compresses, suppositories, tampons. Propolis tincture with alcohol can be bought at a pharmacy and diluted (1 spoon per glass of water) to douche and make compresses.

Prevention

To prevent the development of the disease, it is necessary to regularly visit a gynecologist. Prevention of endometriosis includes the following:

Taking folk remedies and medications that increase immunity.
Abstaining from sex during menstruation.
Timely treatment of gynecological diseases.
Choosing the right contraception to avoid abortion.

It is necessary to be observed by an experienced doctor who will promptly detect the disease, provide assistance, and prescribe treatment. The disease also appears in women who do not have problems conceiving, sometimes it is discovered completely by accident. If your menstruation is painful, occurs more than once a month, but more or less frequently, or does not have a specific cycle, this is a reason to consult a doctor.

Endometriosis is a fairly serious disease. The proliferation of endometrial lesions is most often associated with an imbalance between the volume of hormones present in the blood. Therefore, pills prescribed for contraception are also a means of treating endometriosis.

Doctors approach the selection of these drugs with extreme caution, taking into account not only the characteristics of the woman’s body, but also her age. Injections can be used to treat endometriosis, but at home it is much more convenient to use tablets. The same dosage forms are prescribed to prevent unwanted pregnancy.

There are three ways to simultaneously treat endometriosis and prevent pregnancy. The mechanical method involves the use of special condoms, caps and spirals. According to most women, this is a less convenient method of contraception and treatment. The chemical method involves the use of special suppositories and vaginal creams.

The most convenient are tablets that contain hormones. The best treatment for endometriosis are drugs that are classified as combined contraceptives. This group includes Ciproperone acetate, Drospirenone, Gestodene, Desogestrel.

Why should medications for treating endometriosis after age thirty-five be different from medications prescribed to younger patients? The thing is that at this age a slow decrease in the activity of the processes responsible for conceiving and bearing a child begins.

At the same time, the main female hormones are produced with less intensity. Because of this, an exacerbation of many chronic diseases may begin, since the process also affects the immune system.

But such changes are not a reason to give up intimacy and the likelihood of conceiving a child still exists. Therefore, for contraception, a means must be selected that must meet two requirements at once. It is good to suppress the spread of endometrial tissue outside the uterine cavity and prevent unwanted pregnancy.

The selection of drugs should only be carried out by an experienced specialist. First of all, when choosing contraceptives, the doctor takes into account the presence of a pathology such as endometriosis. In this case, the drug must have a minimum set of side effects and not cause allergic reactions.

When selecting medications, the characteristics of the menstrual cycle and body type should also be taken into account. Since the level of hormones affects the presence of secondary sexual characteristics, the location of the hairline has to be taken into account. The presence of diseases of the reproductive system other than endometriosis is important when choosing a contraceptive method.

Antiprogestins

In this case, the choice primarily falls on the group that includes antiprogestins. These include Danazol, Bonzol, Mifegin. These drugs suppress the production of progestin. They are an almost ideal remedy for both treating endometriosis and preventing pregnancy. But all drugs from this group have a large number of side effects.

Danazol

Danazol - can be used as a contraceptive, but only in large doses. Then the ovulation process is disrupted; with small doses of the drug this does not happen. This remedy slows down the production of follicle-stimulating and luteinizing hormones. Against the background of these processes, the activity of the ovaries decreases. This disrupts the maturation and release of the egg from the follicle. The drug contains synthetic hormones.

This drug is prescribed for endometriosis, since long-term systematic treatment causes partial destruction and atrophy of areas of endometrial tissue located outside the uterus. The effect of the hormonal drug is reversible.

After completing the course, the resulting effect disappears after about ninety days. The maximum effect of the substances included in the drug begins eight hours after taking the tablet. It should be borne in mind that eating fatty foods slows down the rate of action of the drug. The remaining substance is excreted through the kidneys.

The drug should not be used in the presence of cancerous tumors, vaginal bleeding, or serious liver and kidney diseases. Caution is required when taking the drug with high blood pressure. The dosage of the drug is calculated by the doctor on an individual basis. Doctors are advised to prescribe the minimum effective dose. The maximum dose allowed per day is 800 mg. drug.

The most disturbances when taking Danazol are observed in the endocrine system. A woman experiences a flush of blood to her face, the intensity of sweating increases, her body weight increases, her voice may deepen, and the size of her mammary glands may decrease. Under the influence of the drug, the production of secretions by the sebaceous glands increases, against this background skin acne may develop.

From the nervous system, you can expect dizziness, headaches, weakness, and sleep disturbances. Tremors of the limbs may be observed. In rare cases, an increase in intracranial pressure may occur when taking the drug.

In some cases, problems with the gastrointestinal tract may occur. Changes in the blood may also be detected. If an analysis is performed, either an increase or decrease in the number of blood cells may be detected.

If the dosage is violated, the level of testosterone in the blood increases. If the drug is prescribed to patients with diabetes, you should carefully monitor blood sugar levels and adjust the insulin dose depending on this indicator. Reviews from women who took the drug are far from clear. You can find both completely negative and positive ones. Such a variety of opinions is explained by the specific effect of the pills on the body of each individual woman.

Danazol, like another representative of this group, Mifepristone, are potent drugs, and many experts generally recommend their use only in a hospital setting.

AGNRG

Drugs from the group of gonadotropin-releasing hormone antagonists can be used to treat endometriosis and prevent pregnancy. But their use leads to a condition very similar to menopause. The main effect of the drug, in addition to suppressing areas of endometriosis, is disruption of the ovulation process. This group includes the drugs Diferelin, Buserelin, Zoladex.

Zoladex

Zoladex is available in solution and capsules. The active ingredient is goserelin acetate. The drug increases the concentration of the hormone estradiol in the blood. These changes are reversible and disappear within a short period of time after discontinuation of the drug.

When taking capsules, women may experience vaginal bleeding of varying degrees of intensity. With a large dose of the drug, changes characteristic of the onset of menopause may be observed. The drug should not be used to treat endometriosis for longer than six months.

After completing the course of treatment, it is prohibited to reuse the drug. The drug is not used in the usual way for capsules. For treatment, one capsule is injected subcutaneously into the anterior abdominal wall every twenty-eight days.

Allergies to this drug are extremely rare, and anaphylactic reactions can be even less common. Very rarely, an increase in the manifestations of diabetes mellitus may occur. In some women, the drug may cause depression or unexplained mood swings. For this reason, doctors have to stop the drug.

The drug causes increased sweating. Rashes may appear on the skin. Hair loss is very rare. The drug cannot be used for a long time due to the fact that it actively removes minerals from bone tissue. The drug should not be prescribed to patients with polycystic ovary syndrome. The drug is approved for use in diseases of the kidneys and liver, and the usual dose of the drug in this case is not changed. To restore the menstrual cycle after taking the drug, you cannot use hormonal drugs.

Endometriosis is a pathology that is common among women. When the disease occurs, a benign tumor grows outside the uterus. Endometrial growths provoke the appearance of adhesions and inflammatory processes on the tissue of the pelvic organs and other organs. Endometriosis often occurs in combination with other hormonally determined diseases. The exact causes of the occurrence are not yet known, but doctors have identified some prerequisites for the appearance, increased exposure to estrogen, decreased immunity, and inflammatory reactions.

Treatment methods

Before starting treatment, you need to consult a doctor who will carefully study the medical history and be able to choose the right method that will not harm the patient.

Surgical method

It is used only after unsuccessful results of drug treatment. During treatment, a gentle intervention or a much more serious one, in which the pelvic organs are removed, is possible. A gentle method includes laparoscopy, which is often used by modern doctors. It allows surgery to be performed through a small incision using laser therapy or electrocoagulation.

Medication method

The method involves prescribing a woman a course of hormone therapy for endometriosis. These medications normalize the level of estrogen in the body and stabilize the functioning of the ovaries; hormones also stop endometriotic foci of inflammation. Used in the early stages or in combination with a surgical method. The patient's intake of hormonal drugs leads to the restoration and stabilization of her hormonal balance, which helps eliminate the symptoms of the disease. The basis of hormonal treatment for endometriosis is the cessation of menstruation caused by drugs to achieve positive results

Hormone therapy

Pros of hormone therapy:

Reduced pain;
Possibility to do without surgical intervention;
Preservation of a woman's reproductive capacity;

Disadvantages of hormone therapy:

Long-term use of hormonal drugs for endometriosis leads to disruptions in the functioning of the body;
Possibility of dependence on the drug;
Possible relapse;
Long duration of treatment;

In rare cases, hormone therapy for endometriosis has contraindications, so doctors select some other medications for the patient.

Contraindications to hormone therapy:

Allergic reactions to the drug;
Disruptions in the endocrine system;
Liver diseases;
Ulcer or gastritis;
Failures in the hematopoietic system;
Thrombosis;
Kidney diseases;
Diabetes;

Side effects:

The onset of depression;
Disruptions in the menstrual cycle;
The appearance of stable migraines;
Weight gain;
Edema;
Nausea;
Uterine bleeding;
Weakening of the immune system;
Metabolic failures;

Treatment of endometriosis - video

Drugs for treatment

Hormones for endometriosis can be divided into several groups, which differ in purpose and effect, because patients come with different symptoms and are prescribed different drugs.

Agonists

Drugs that help stop menstruation and reduce estrogen production. When using them, signs of menopause may appear.

Preparations:

Diferelin (requires intramuscular administration from the beginning of the cycle for 1-5 days, a repeat course is given after a month);
Decapeptyl Depot (injected into a vein, also in the first days of the cycle, repeated after 28-30 days);
Zoladex (injected into the abdominal cavity, effective for a month);
Buserelin (injected into the muscle within a month from the first days of the cycle);
Lucrin-Depot (injection is carried out on the third day of menstruation, the procedure is repeated a month later);

Antigestagens

Drugs of this group lead to inhibition of the development of endometriotic cells, including those that begin their development outside the uterine cavity. When using the products, body hair, weight gain and acne may appear.

Preparations:

Danazol (capsules, dosage and time of administration are prescribed by a doctor);
Mifepristone, Gestrinone (cause anovulation, take no more than 200 mg per day);

Gestagens

For homeopathy for endometriosis, the doctor may prescribe progesterone analogues. Which act to suppress the proliferation of endometriosis cells, since with their greater predominance they are able to better suppress the estrogen hormone than other drugs.

Preparations:

Duphaston (can be replaced with Norkolut) (tablets that are taken from the 5th to the 25th day of the cycle and are also taken again in the new menstrual period, the treatment is gentle, since the effect occurs only on the endometrium);
Visanne or Femoston (femoston for endometriosis is taken every day in the amount of 1 tablet, the effect is on the growth of the endometrium and on the cessation of menstruation);
Orgametril (used to stop and appear foci of endometriosis, taken from the 14th to 25th day of the cycle, 1 tablet every day, in case of severe bleeding, the doctor can increase the dose to 2 tablets, used only in the first stages of the disease);
Utrozhestan (Utrozhestan for endometriosis is taken in the form of tablets and vaginal suppositories, the dosage is prescribed by a doctor);
Norkolut (norkolut helps block ovulation, it is not recommended to use during pregnancy or when planning pregnancy);

Oral contraceptives

Treatment with birth control pills for endometriosis can not only act as intended - regulating the reproductive system of the female reproductive system, but also act with the help of homeopathy on foci of inflammation, reducing their activity. In addition, contraceptives contain a gestogenic component, which can affect the course of the disease and have a positive result.

In order for the treatment to be successful, it is recommended to take OK in the treatment of endometriosis for six months; if a positive effect is achieved with the help of these tablets, the doctor may increase the course. Patients who have used them in their treatment for endometriosis leave only positive reviews.

Combined oral contraceptives (COCs) are one of the most popular types of hormonal contraception. In addition to its main function, COCs reduce the amount of bleeding during menstruation and reduce the level of pain, and have a positive effect on the emotional state of a woman.

Also, the advantages of COCs are that there are a small number of risk factors and possible side effects, which gives the patient a feeling of confidence when receiving homeopathy treatment. But the drugs have their own contraindications due to age; it is better not to take COCs for women over 35 years of age.

Preparations:

Janine;
Yarina;
Claira;
Dimia;
Jas;
Marvelon;
Diecyclen (diecyclen is most often prescribed for endometriosis);
Lactinet;
Jess;

Remember, in order to know what medications you need to take, you should definitely consult a doctor; women over forty years old need to take this issue especially seriously. Read the instructions for use carefully.

The most popular prescribed drugs for hormone therapy for endometriosis are:

Norkolut

Norkolut is taken from the 5th to the 25th day of the cycle, for six months, further continuation of the course is considered by the doctor. Side effects include: migraines, nausea, fatigue, thrombosis. When using Norkolut, it is necessary to exclude the possibility of malignant tumors in the body; skipping the drug is not recommended.

Contraindications when using Norkolut:

Kidney and liver diseases;
Thrombosis;
Bleeding of the ureter;
Large body weight;
Herpes;
Allergic reactions;

The use of Norkolut during pregnancy and lactation is prohibited.

Terzhinan

Terzhinan has antifungal and antibacterial properties and is also used for inflammation. Side effects of Terzhinan include the appearance of allergic reactions.

The use of Terzhinan during pregnancy is possible only from the second trimester. The course of treatment with Terzhinan lasts from 10 to 20 days.

Jess

The drug Jess is taken for 28 days, one capsule per day. It is allowed to start taking the medication from day 3-5 of the menstrual cycle. After menopause (for women over 40 years old), Jess is not discharged.

Jess should not be used during pregnancy and breastfeeding.

Side effects of Jess include migraines, nausea, and pain in the genitals.

Orgametril

Orgametril suppresses ovulation and menstruation. Orgametril is contraindicated for liver disease, contraindicated during lactation and pregnancy, herpes. Side effects of Orgametril include: nausea, weight gain, irritability, depression, chest pain.

Orgametril is taken from the 14th to 25th day of the menstrual cycle.

Metipred

Metypred is contraindicated for women with stomach diseases, infectious and fungal infections, and diseases of the cardiovascular system.

The dose of Metipred is prescribed by the attending physician.

Side effects of Metipred include: vomiting, pancreatitis, arrhythmia, depression, paranoia.

Use during pregnancy when prescribed by a specialist.

Lactinet

Lactinet is contraindicated in case of liver diseases, thrombosis, lactose intolerance, diabetes mellitus. The use of Lactinet begins on the first day of the menstrual cycle. After termination of pregnancy, Lactinet is taken as prescribed by a doctor, depending on the trimester in which the termination occurred. Contraindicated during pregnancy.

Side effects of Lactinet: nausea, irritability, decreased libido, redness of the skin.

Take care of your health and do not neglect the prescribed hormonal treatment for endometriosis, this way you will achieve quick results.

In recent years, there has been a clear trend towards increasing frequency endometriosis, which occupies one of the leading places in the structure of gynecological diseases. According to various authors, endometriosis occurs in the population in 5–10% of all women of reproductive age and in 20–30% of women with primary and secondary infertility.

http://www.7gy.ru/ treatment

Endometriosis is a pathological process of benign growth in various organs of tissue similar in structure and function to the endometrium - the inner lining of the uterus, rejected during menstruation. At endometriosis endometrial growths undergo cyclical monthly changes, have the ability to penetrate into surrounding tissues and form extensive adhesive processes. In other words, Endometriosis characterized by the proliferation of endometrioid heterotopias in the form of glands and endometrial stroma outside the uterus, which are similar in structure and function to endometrial tissue. Often endometriosis is combined with other hormonally caused diseases, in particular, uterine fibroids, hyperplastic processes of the endometrium and a number of others.

Endometriosis– a gynecological disease in which the formation of nodes similar in structure to the inner mucous membrane of the uterus (endometrium) occurs, located inside the uterus, as well as outside it. Every month, if the egg is not fertilized, the uterine tissue, prepared for the attachment of the fetus, is rejected. However, it may happen that, along with the blood flow, the endometrium will fall back into the fallopian tubes and begin to grow. This is the beginning of the development of endometriosis. The disease affects women of childbearing age, women who are more often exposed to stress than others.

Endometriosis- proliferation of the uterine mucosa (endometrium) or the entry of individual cells into organs and tissues where they should not normally be. Moreover, in these places the endometrium behaves like in the uterus - it increases during menstruation. First of all, endometriosis affects the pelvic organs: ovaries, fallopian tubes, rectal uterine ligaments, and bladder. Endometriosis is also found in distant organs, such as the lungs or the nasal mucosa.

Causes of endometriosis.

The first mention of a disease with characteristic endometriosis symptoms and a description of his treatment are found in the Egyptian Ebert papyrus. There are many theories explaining the cause of endometriosis, but none of them fully reveals the mechanisms of its development and the variety of forms of manifestation.

Currently the cause of endometriosis explain, for example, genetic predisposition And theory of hormonal development of the disease, according to which the origin of endometriosis is associated with a disturbance in the quantity and ratio of hormones in a woman’s body. This is confirmed by certain changes in the foci of endometriosis throughout the menstrual cycle and the reverse course of the disease during pregnancy and postmenopause.

Implantation theory of endometriosis suggests that rejected endometrial particles in certain situations, for example, surgical abortion, traumatic childbirth, reflux of menstrual blood from the uterus into the tubes during spastic contractions of the uterus during menstrual pain, settle on the ovaries, tubes, peritoneum and give rise to the development of endometriosis.

However, the most important ones seem to be negative changes in the neuroendocrine system due to stress, poor nutrition, general somatic diseases, dysfunction of the endocrine glands, infection of the genital organs, smoking.

Causes endometriosis are not fully known. The etiology and pathogenesis of endometriosis is not fully understood. A major role (along with other factors) is currently given to the retrograde reflux of menstrual blood and endometrial fragments from the uterus into the abdominal cavity and the implantation of endometrial sections by dissemination of endometrioid tissue through the blood and lymphatic vessels.

Endometriosis in places remote from the pelvic area, may be a consequence of the transfer of endometrial fragments through the blood and lymphatic vessels. The causes of endometriosis are not well understood. Often endometriosis is combined with infertility.

Factors that may influence the development of endometriosis:

hormonal disorders,
thyroid diseases,
complicated childbirth or abortion,
frequent intrauterine manipulations (including diagnostic and therapeutic),
operations with opening of the uterine cavity,
inflammatory diseases of the genital organs,
menstrual irregularities,
hereditary predisposition,
overweight,
alcohol abuse, caffeine, smoking.

How does endometriosis develop?

Normally, during each menstrual cycle, the endometrium (inner mucous lining of the uterus) matures and is shed along with menstrual flow. But for reasons that have not yet been clarified, endometrial cells can begin to travel throughout the body.

Through the fallopian tubes they enter the peritoneum, sit there on neighboring organs or sink into the thickness of the uterine wall, taking root and beginning to function like the normal endometrium inside the uterus.

Every menstrual cycle outbreak endometriosis increases in size, weaving something like a web in the tissues, swelling and bleeding. At the same time, the fluid that the endometrial cells produce does not flow out - hence the pain. In response to irritation, adhesions form in the abdominal cavity, and obstruction of the fallopian tubes develops. If endometriosis affects the ovary, cysts often form there - cavities filled with liquid contents. The existence of such a cyst naturally disrupts the functioning of the ovary: there is a risk of infertility.

Types of endometriosis

Depending on the localization of the process, there are genital(damage to the genital organs) and extragenital(located anywhere outside the genitals) endometriosis. Genital, in turn, is divided into interior(damage to the body of the uterus) and outer(damage to the cervix, vagina, ovaries, fallopian tubes, pelvic peritoneum, etc.).

Usually, endometriosis has the appearance of separate or merging with other tissues of small lesions (nodes, nests) of round, oval and irregular shape, the cavities of which contain dark, thick or transparent liquid. Endometrioid formations can consist of many small cystic cavities (cellular structure) or acquire the character of a cyst (for example, endometrioid or “chocolate” ovarian cyst).

Forms of endometriosis:

Peritoneal form of endometriosis may vary in the strength of pigmentation (white, red-blue, brown-black), fibrosis.

cystic ovarian form of endometriosis characterized by the formation of endometriotic ovarian cysts. The number of adhesions and their nature are important in this diagnosis.

rectovaginal form of endometriosis divided into deep (in the uterus) and superficial (ovaries, fallopian tubes, uterine and intestinal ligaments).

Symptoms of endometriosis.

Main clinical symptom of endometriosis is dysmenorrhea of varying severity. The cause of painful menstruation is cyclical menstrual-like changes in endometrioid heterotopias, which secrete fluid containing prostaglandins, which are powerful stimulators of uterine contractions and vascular tone.

Dyspareunia, premenstrual and postmenstrual bleeding, hyperpolymenorrhea, dysuria And infertility– here is an incomplete list of clinical symptoms, manifestations and complaints of patients with endometriosis.

Pain and enlargement of formations and organs affected by endometriosis appear on the days of menstrual bleeding. Then the pain subsides and the formations decrease. May occur uterine bleeding, enlarged uterus. Endometriosis is sometimes asymptomatic.

Possible symptoms of endometriosis:

pain before menstruation
pain during bowel movements and urination
pain during intercourse
menstrual dysfunction
intermenstrual bleeding
infertility

Endometriosis usually manifests itself as pain that gets worse before and during menstruation. The severity of the pain leads to an erroneous diagnosis of endometriosis as appendicitis or ectopic pregnancy. The pain is localized depending on where the endometriosis occurs - for example, it may occur during bowel movements or urination. Correct diagnosis of endometriosis is the first step to successfully treating endometriosis.

The disease may not manifest itself at all, and the patient learns about it only during a preventive examination with a doctor.

Endometriosis is characterized by a long and progressive course. The sooner the patient consults a doctor, the greater the chance of restoring reproductive function.

Diagnosis of endometriosis

Due to implicit symptoms of endometriosis at an early stage and manifestations symptoms, characteristic of many other diseases, women do not immediately consult a doctor. But the earlier endometriosis is diagnosed, the more successful the treatment and the greater the chance of a full recovery.

Treatment of endometriosis.

For treatment of endometriosis are used medicinal, surgical methods, as well as a combination of methods. Early diagnosis allows you to avoid surgical intervention, limiting yourself to medication methods.

Drug treatment of endometriosis is the purpose hormonal drugs which the patient has been taking for a long time. They normalize the functioning of the ovaries and prevent the appearance of new lesions. However, this method is effective only at the initial stage of the disease, when cysts have not yet appeared. It is worth noting that for retrocervical endometriosis, hormonal therapy is ineffective. In addition, there are a number of contraindications for its use.

TO surgical treatment of endometriosis resort when necessary remove endometrioid ovarian cyst or when Conservative treatment of endometriosis has not yielded results. Currently, a method based on laparoscopy, which allows surgery to be performed through a small incision using electrocoagulation or laser. However, after the operation it is necessary to undergo a course of medication and a course of physiotherapy to normalize the menstrual cycle. In the case of a severe form of the disease and if the woman does not plan to have more children, the uterus is completely removed.

Drug treatment of endometriosis

Main methods treatment of endometriosis are surgical and medicinal, each of which has its own indications and contraindications, advantages and disadvantages, and in general, the goals and place of each of them in the management of patients are defined. Currently, along with the already traditional medicinal methods treatment of endometriosis, such as the use of antiprogestins (danazol and its analogs, mifepristone), GnRH agonists (buserelin, goserelin, etc.), the use of contraceptive hormones in the treatment of this complex disease is actively used and studied.

The purpose of drug treatment for endometriosis- stop its progression by suppressing the secretion of estrogen by the ovaries, in particular, the most active of them - 17b-estradiol, suppress ovulation, induce hypoestrogenism, cause atrophy of endometriosis foci. This method of pharmacotherapy has received special attention in recent years due to its high acceptability and relatively small number of adverse reactions.

Modern drugs used to treat endometriosis:

1. Antiprogestins (danazol and its analogues, mifepristone) in the treatment of endometriosis.

Danazol has long been a reference method for the treatment of endometriosis, as it was and is very effective. By suppressing the secretion of gonadotropins, the drug causes reversible drug-induced amenorrhea, suppresses the secretion of estradiol by the ovaries and has a direct inhibitory effect on endometriotic lesions. But during its use, adverse reactions occur in the majority of patients (up to 85%): weight gain, symptoms of hyperandrogenism (breast reduction, hirsutism, edema, depression, etc.), which is due to its androgenic and anabolic effects, in particular, changes in tolerance to glucose. Available data on the possibility of using the antiprogestin mifepristone are insufficient for objective conclusions.

2. GnRH agonists (buserelin, goserilin, etc.) in the treatment of endometriosis.

The action of GnRH agonists is also indirect through the hypothalamus-pituitary gland, resulting in a decrease in gonadotropic and then ovarian secretion and atrophy of endometriotic foci. GnRH analogues do not have an androgenic and anabolic effect, but can have a negative effect on bone metabolism, sometimes causing bone resorption when used for more than 3 months. The condition that occurs with their use is drug-induced menopause with the frequent development of menopausal syndrome, sometimes requiring the use of HRT.

Gonadotropin-releasing hormone agonists is a group of drugs that have been used to treat endometriosis for 20 years. They are slightly modified natural gonadotropin-releasing hormones that affect the course of the menstrual cycle.

All gonadotropin-releasing hormone agonists are chemically similar but come in a variety of forms: trimonthly injections, monthly injections, daily injections, and nasal spray (that is, administered into the nasal cavity).

All gonadotropin-releasing hormone agonists have the same effect on the body. When used for more than 2 weeks, they stop the production of estrogens (female sex hormones). This leads to a decrease in the activity of endometriotic lesions and their reverse development.

Most women with endometriosis bleeding stops after 2 months from the start of treatment. however, some of them may experience vaginal bleeding within 3 to 5 days after starting treatment, or spotting for 10 to 14 days.

Usually a decrease in symptoms and endometriosis symptoms observed within 4 to 8 weeks from the start of treatment, however, in the first two weeks there may be some deterioration in well-being. The reason for this is that it takes some time for the body to completely stop producing hormones. During this phase, estrogen levels rise and thus stimulate disease manifestations until the stabilizing effect of gonadotropin-releasing hormone agonists occurs.

Restoration of ovulation and menstruation after treatment of endometriosis may fluctuate within different limits. For most women, menstruation returns within 4 to 6 weeks after the final use of buselerin or nafarelin nasal spray, or within 6 to 10 weeks after the last injection of goselerin, leuprorelin, or triptorelin.

3. Contraceptive hormones: estrogen-progestogen and progestogen compounds in the treatment of endometriosis.

The history of the use of gestagens is the oldest. Since the 1950s, it has been known that the combination of relatively large doses of oral estrogens and progestins initiates amenorrhea and endometrial changes that mimic the early stages of pregnancy. In 1956, R. Kistner concluded that suppression of menstrual bleeding and induction of pseudopregnancy in the endometrium could be therapeutically beneficial for women with endometriosis. However, the author used dosages that are perceived today as very high (up to 0.6 mg/day ethinyl estradiol and 40 mg/day norethinodrel), which caused a number of adverse reactions due to the need for long-term treatment and residual androgenic effects.

The introduction of new progestational components and a reduction in estrogen dosages, the effectiveness of modern combined oral contraceptives (COCs) has increased significantly, especially in complex anti-relapse therapy endometriosis. Adverse reactions when using them are less pronounced, they do not affect metabolic processes, drug-induced amenorrhea does not occur, and therefore this group of drugs is especially acceptable for young patients.

However, a number of studies have shown that the main side effects that occur when taking COCs appear during the seven-day interval without taking the drug. In order to reduce the number of adverse reactions, and also taking into account that the effect of COCs depends on the duration of use and reaches a maximum at the end of the treatment cycle, and over the next 7 days of the interval the level of natural gonadotropins increases, a regimen of prolonged use of combined oral contraceptives was proposed. Currently, long-term use (in long-term dosing regimens) of low-dose oral contraceptives containing 20 mcg ethinyl estradiol has been successfully used as maintenance therapy after a full course of GnRH agonists in patients with endometriosis. This regimen is most indicated for patients with partial pain relief from the use of GnRH agonists, who require long-term therapy and who are planning pregnancy. Long-term use of low-dose oral contraceptives is also used in women with recurrent pelvic pain after surgery for endometriosis.

With the standard regimen of COC use (21 days with an interval of 7 days), women experience a number of problems associated with menstruation during a break from taking COCs. A prospective, open-label clinical study showed that 74% of women who received COCs in a prolonged regimen (63 days of taking tablets followed by a seven-day break) noted a decrease in the severity of complaints and symptoms that bothered them.

Application for treatment of endometriosis only gestagens (norethysterol, dydrogesterone, etc.) in a continuous mode and in the necessary quantities, i.e. large doses, even when using progesterone derivatives, led to inevitable “breakthrough” and prolonged bleeding, metabolic disorders, which reduced the acceptability of the method.

Progress in contraception and improvement of progestogens have made it possible to create compounds with new properties, which have identified new opportunities for differentiated therapy.

Attracts attention progestogen dienogest. The progestogen dienogest has been called a “hybrid” progestogen because. unlike others, it has the properties of both progesterone derivatives and norsteroids. Later, after studying the properties of dienogest, the drug Janine was synthesized on its basis, which opened up new possibilities in the treatment of endometriosis with contraceptive hormones.

Dienogest– the first progestogen, structurally similar to 19-nortestosterone, has clinically significant antiandrogenic activity and has virtually no effect on lipid metabolism, which determines its similarity to progesterone derivatives. Like 19-norsteroids, it has high bioavailability, and therefore small doses are sufficient for biological effects. When combined with ethinyl estradiol (EE), it provides good cycle control (no intermenstrual bleeding) and has pronounced gestagenic properties due to high specificity for gestagen receptors. It has in common with progesterone derivatives a relatively weak antigonadotropic and strong peripheral effect, manifested in the suppression of 17b- secretion estradiol by the ovaries, the absence of androgenic activity and a fairly pronounced antiandrogenic effect.

Through clinical studies, it has been shown that dienogest is able to actively influence the clinical manifestations of endometriosis both indirectly - through the suppression of estradiol secretion by the ovaries, and directly on endometrioid heterotopias, while also providing an antiandrogenic effect on the skin and practically without affecting metabolic processes. It is extremely important that this requires a significantly lower therapeutic dose than when using a number of other progestogens.

Many experimental and clinical studies have been conducted regarding the effectiveness of various doses of dienogest, its effect on lipid and carbohydrate metabolism, and its effect directly on endometriotic heterotopias. A number of studies comparing the effectiveness and acceptability of GnRH analogues and dienogest have shown promise for the use of dienogest in endometriosis, especially in young women.

S. Moore et al. (1999) provide data on 267 patients with endometriosis who received treatment with dienogest for 6 months. According to their data, its effectiveness was comparable to danazol and GnRH agonists, but safety and tolerance were significantly higher. The results of endoscopy after 6 months of treatment objectively indicated the complete disappearance of endometrioid heterotopias or their partial remission in 85% of patients. With further observation for 6 months. relapses of the disease were noted only in 7.7% of women. Acceptability of the medications was high. Systemic side effects included nausea, headaches, and depression; their frequency was small (10.5%). At the same time, many women noted an improvement in their skin condition, a decrease in acne, and hirsutism. There were no significant changes in blood pressure, weight, liver function, blood lipid profile or body weight.

In a number of subsequent studies, it was shown that dienogest has a pronounced direct inhibitory effect on the proliferation of endometrioid heterotopias, causing their almost complete regression.
M. Cosson et al. (2002), comparing the results of treatment of endometriosis with dienogest and decapeptyl, showed their equal effectiveness. However, as the authors noted, “dienogest represents a new therapeutic alternative to GnRH analogues due to better tolerability.”

As already noted, active progestogens are usually used for therapeutic purposes in combination with estrogens, because continuous use as monotherapy reduces their acceptability and often prompts patients and physicians to abandon this treatment method. The main reason is “breakthrough” bleeding due to rapid atrophy of the endometrium, because it is more sensitive to gestagenic influences than endometrioid tissue. Adding a small dose of semi-synthetic estrogen (ethinyl estradiol) avoids this effect.

Dienogest is part of the drug Janine– a combined oral contraceptive containing 30 mcg ethinyl estradiol and 2 mg dienogest. Clinical studies have shown that Janine has good cycle control. Intermenstrual and breakthrough bleeding with the usual contraceptive regimen of taking the drug was extremely rare. However, hypomenorrhea and amenorrhea were much more common. So, according to S. Moore et al. (1999), the number of women with scanty menstruation increased 2–3 times with increasing duration of taking the drug for contraception; amenorrhea occurred in 10% of patients. However, what reduced the acceptability of dienogest for contraception (hypo- and amenorrhea) turned out to be very positive in the treatment of endometriosis.

Extremely important is the antiandrogenic effect of the drug, which is realized through a decrease in the level of total testosterone (by 20–40%) and free testosterone (by 45–60%). Of the 11 thousand women who received Janine for 6 cycles, 73% of them, after the end of treatment, noted a significant improvement in their skin condition, the disappearance or reduction of acne.

A number of studies have shown the absence of a negative effect of Zhanine on the blood lipid spectrum, carbohydrate metabolism and hemostasis parameters, which determines its good acceptability.

In recent years, the use of contraceptive hormones has undergone revision. There was a clear tendency to reduce the interval between cycles of taking tablets, which provides a greater inhibitory effect on the HNS and fewer adverse reactions. So-called prolonged contraception schemes are being introduced into clinical practice, when drugs are used continuously for more than 60 and 80 days. This regimen is especially promising for use for therapeutic purposes, including the treatment of endometriosis. Already at the present time we can talk about the positive experience of using the drug Zhanine according to an extended regimen in treatment of endometriosis. In general, as experience and research show, the interval between cycles of administration should not exceed 4 days with a traditional treatment regimen, and the duration of treatment is individual.

Studies have been conducted on the use of endometriosis a combined oral contraceptive containing 2 mg dienogest in a prolonged regimen (63 days of taking active tablets followed by a seven-day break), in the treatment of 59 patients with adenomyosis. Of these, 32 were patients diagnosed with retrocervical endometriosis and cervical endometriosis, in whom Janine was used as an independent method of treatment, and 27 women in whom Janine was used after surgical treatment (coagulation of endometriosis foci during laparoscopy). The treatment results indicate the high effectiveness of therapy, both as an independent monomethod and as an anti-relapse postoperative therapy. In particular, relief of the main clinical symptoms (disappearance of dysmenorrhea, decrease in menstrual blood loss, decrease in the severity of pain) and good tolerability of treatment in most patients were noted.

According to ultrasound screening data, a clear trend towards a decrease in the severity of adenomyosis and a decrease in size was identified endometriosis against the background of treatment. The main side effects of therapy were spotting, most often manifested in the first three months of taking the drug, but in no patient this was the reason for refusing to continue therapy. The effectiveness of treatment in 2 groups of patients was 94.6 and 89.7%, respectively. Thus, dienogest is more acceptable compared to other types of pharmacotherapy in patients of reproductive age due to its high efficiency, good tolerability, the presence of a menstrual-like reaction, and a small number of adverse reactions.

A survey of 365 obstetricians and gynecologists was conducted to determine their attitude and possible experience of using combined oral contraceptives in a prolonged mode. 58% of respondents noted that they already had similar experience in using COCs for treatment of endometriosis with a positive clinical effect.

Let us summarize the literature data and clinical experience: the drug Zhanine, which includes dienogest, can be recommended in the following situations:

As an independent method when surgical treatment is not indicated or contraindicated;
as a means of preoperative therapy;
for anti-relapse therapy after surgical treatment.

However, it should be noted that the issue of a prolonged treatment regimen should be decided strictly individually for each specific patient, taking into account possible indications and contraindications.

Thus, drug treatment of endometriosis involves the possibility of using drugs of various groups and properties, but some of the most effective and with minimal side effects are contraceptive hormones.

Currently, in relation to treatment of endometriosis with contraceptive hormones A number of publications have appeared (for example, “Progestogens for the treatment of endometriosis: a return to the past”), which, based on modern studies of new drugs, substantiate the prospects of this area of pharmacotherapy. There are reports of the promise of using synthetic progestins in combination with gonadotropin agonists, which are more effective than other methods. These perspectives are based on the results of clinical studies.

Duphaston for endometriosis

Duphaston is a hormone therapy drug and is used to correct various pathological conditions associated with progesterone deficiency. The drug contains the active ingredient – dydrogesterone. Duphaston is an analogue of natural progesterone and ensures the normal course of many physiological processes in a woman’s body.

Duphaston allows you to reduce the lack of progesterone in the female body and prevent or significantly improve the unfavorable course of many gynecological diseases. Duphaston belongs to a new generation of hormonal therapy drugs, since dydrogesterone, which is part of it, is not a testosterone derivative and does not have the side effects that androgenic progestogens have.

Duphaston is quite widely used in the treatment of diseases of the female genital area such as endometriosis, threatened or habitual miscarriage, irregular menstrual cycle (dysmenorrhea), PMS, infertility caused by luteal insufficiency, etc.

Progesterone is the hormone of the second phase of the menstrual cycle and its action is to balance the action of estrogens. Lack of progesterone can provoke the development of endometriosis, a hormonally dependent disease in which the endometrium grows. The use of Duphaston suppresses endometriosis and promotes regression of disease foci. The drug is prescribed in the complex treatment of the disease, along with such a minimally invasive surgical method as laparoscopy.
Duphaston is also indicated for a disease characterized by painful periods - dysmenorrhea. The processes in the female body that accompany this disease lead to increased formation and release of prostaglandins. High levels of the latter cause hypoxia and ischemia of the myometrium, which leads to spastic contractions of the uterus, which are accompanied by anoxic pain. Prescribing Duphaston to patients with dysmenorrhea allows them to relieve pain, improve their overall well-being and not block the ovulation process.

A sufficient amount of progesterone plays a major role in the successful course of pregnancy, since even before conception it prepares the uterus to accept the embryo and switches the maternal immune response from rejecting the fetus to protecting it. In case of habitual miscarriage, Duphaston allows you to recreate the natural mechanism of the normal course of pregnancy. Dydrogesterone, which is part of the drug, compensates for the lack of progesterone in the body and prevents the development of embryotoxic effect, which leads to miscarriage in the first trimester. It is very important that there are no side effects on the mother and child while taking the drug. This distinguishes Duphaston from drugs of previous generations, which were used at the end of the 20th century. Positive reviews of the use of Duphaston have made it possible to actively use it during the treatment of infertility and in vitro fertilization.

Doctors also associate the occurrence of premenstrual syndrome, which is familiar firsthand to most of the female population, with a lack of progesterone in the second phase of the cycle and with an increase in estrogen levels. Taking Duphaston reduces the intensity of uterine contractions and its sensitivity, which relieves pain; normalizes a woman’s well-being and her emotional state; reduces swelling.

However, like any drug, Duphaston has its contraindications. Thus, individual intolerance to the components of the drug, Dabin-Johnson syndrome, Rotor syndrome are contraindications to taking Duphaston. While taking the drug, you should not breastfeed, since dydrogesterone is excreted in breast milk. When prescribing hormone replacement therapy, a preliminary general medical examination must be carried out. This is necessary because in combination with estrogen, the use of dydrogesterone should not be prescribed to patients with cardiovascular diseases, epilepsy, diabetes mellitus, migraine, and existing renal impairment.

Complications of endometriosis treatment

Recommendations for preventing side effects of hormone therapy are valuable. endometriosis. In order to prevent the negative effects of long-term hormone therapy on the organs of the gastrointestinal and hepatobiliary systems, it is recommended to prescribe drugs that support the functions of these organs.

If there is a history of hepatitis, cholecystitis, or pancreatitis, then treatment with drugs that support the functions of these organs is started simultaneously with hormonal therapy for endometriosis.

The food regimen includes vitamins, cottage cheese, oatmeal and other lipotropic components of the diet; in agreement with the therapist and under his supervision, decoctions of choleretic herbs and other remedies are used.

According to indications, Pancreatin, Festal and other drugs that support pancreatic function are prescribed. Patients with gastric ulcers, duodenal ulcers, and gastritis are recommended to use methyluracil (0.5 g 3-4 times a day) and sea buckthorn oil (1 teaspoon 2-3 times a day) during hormone therapy.

For cholelithiasis, hormone therapy is carried out after cholecystectomy; Treatment with hormones is preceded by the removal of varicose veins on the legs.

If endometriosis is accompanied by anemia, then treatment with hormones is combined with the use of hemostimulating iron preparations; in the presence of hypoproteinemia, amino acid complexes and protein hydrolysates are administered.

Hormone therapy is carried out in combination with other methods of pathogenetic therapy. These include drugs that affect the nervous system, in particular the patient’s emotional reactions, eliminate pain, reduce perifocal inflammatory processes and their consequences (scars, adhesions).

Experience shows that most patients endometriosis neurotic disorders are noted, often manifesting themselves in the form of negative emotions and an inadequate attitude towards their illness. Emotional stress contributes to the appearance of neuroendocrine disorders, changes in the functions of the sympathetic-adrenal and pituitary-adrenal systems. Therefore, psychotherapy is an important part of the complex pathogenetic therapy of endometriosis. Of great importance are the creation of the correct attitude towards all manifestations of the disease and psychological preparation for a long treatment of endometriosis, as well as correct assessment of treatment results. If necessary, minor tranquilizers, valerian, motherwort, etc. are prescribed.

Painkillers and methods are an important part of a comprehensive treatment

Endometriosis is a disease characterized by the proliferation of endometrial cells outside the inner layer of the uterine wall. With endometriosis of the uterus, endometrioid lesions lead to inflammation of adjacent tissues, resulting in the development of adhesions, scars and cystic neoplasms. To suppress foci of the disease, the doctor selects hormonal pills for uterine endometriosis.

The essence of hormonal treatment for endometriosis

The goal of hormone therapy for endometriosis is to stop the growth and reduce endometrioid pathological growths by suppressing the production of estrogen. Some hormonal drugs for endometriosis affect the ovaries, which are responsible for the production of estrogen, while others affect the pituitary gland, which takes part in the production of hormones. Hormonal therapy is carried out in long courses.

There are 3 ways to treat the disease:

Imitation of pregnancy. Combined hormonal medications are taken, which contain estrogen and progestin, which simulate the onset of pregnancy in the body, blocking ovulation. Progestin can also be used separately, since it leads to a reduction in the size of endometrial tissue.
Simulating menopause. Hormonal medications are prescribed to help reduce the level of sex hormones to a minimum concentration.
Suppression of ongoing ovulation. To do this, the doctor prescribes medications containing synthetic androgen, which is a natural sex hormone in men. These medications are excellent at blocking ovulation, but have many side effects.

GnRH agonists

GnRH agonists restore the connection between the pituitary gland, hypothalamus and ovaries in women suffering from endometriosis.

When treating with this group of drugs the following is observed:

development of artificial menopause;
loss of sensitivity of pituitary cells;
decreased release of gonadotropin compounds.

These effects occur because gonadotropin binds to GnRH receptors located in the adenohypophysis. With regular administration of medications, the release of gonadotropin stops. This causes absence of menstruation.

Progestogens

Progestogens are a class of steroid hormones that bind to and activate the progesterone receptor. Drugs in this group cause a decidual reaction and help reduce the growth of endometrial tissue.

Gonadotropic hormone inhibitors and antigestagens

Such hormonal pills are prescribed when diagnosing endometriosis to suppress FSH, LH and progesterone. Inhibitors of gonadotropic hormones and antigestagens affect the functioning of the ovaries, blocking the production of estrogen and stopping the growth of pathological endometrial cells.

Pharmacy drugs

Pharmacies sell a large number of hormonal drugs for the treatment of endometriosis.

Zoladex (Goserelin)

Active ingredient of the drug: goserelin acetate. Goserelin is a synthetic analogue of natural gonadotropin-releasing hormone. When taken regularly, the medication inhibits the pituitary gland's release of luteinizing hormone, reducing the concentration of estradiol in the blood in women. During the treatment of endometriosis, the drug helps reduce pain, the size and number of endometrioid lesions. The medication in an amount of 3.6 mg is injected into the shoulder or abdomen every 28 days. The course of treatment lasts for six months.

Buserelin

The drug normalizes hormonal balance, causing thinning of the endometrium. The active ingredient of the drug is buserelin acetate. The drug is available in the form of a nasal spray and solution for injection.

With regular use of the medicine, the production of the hormone estrogen stops. The effectiveness of the drug appears after 2-3 months of treatment. In most cases, the duration of the treatment course is 6 months.

The daily dose of nasal spray is 900 mcg. The dosage of 1 injection depends on the patient’s body weight. The course of therapy consists of 6 injections, which are administered once every 4 weeks.

Diferelin

The active component of the long-acting medication is triptorelin acetate. The drug suppresses ovarian function.

When used regularly, the drug provokes the onset of artificial menopause in women. In parallel with the central action, the drug affects peripheral receptors, helping to reduce their sensitivity to the factor that is responsible for the release of gonadotropin.

In the presence of endometriosis, the dosage is 3.75 mg every 28 days. The injection should be administered in the first 5 days from the start of the menstrual cycle. Therapy for the disease can last up to 6 months.

Utrozhestan and Duphaston

The active component of Duphaston is dydrogesterone, which is a progestogen that is effective when taken orally. The active component of Utrozhestan is progesterone. These medications fully ensure the onset of the secretion phase in the endometrium, reducing the risk of developing hyperplasia.