Efficacy of gestagens in the prevention of ovarian endometrioma recurrence after surgical treatment R.I. Gabidullina, A.Sh. Zaripova, F. F. MINNULLINA, DINARA I. AKHMETOVA Voprosy Ginekologii Akusherstva I Perinatologii, 2025 Ovarianendometriomas occur in 55% of women with endometriosis. Cystectomy is considered the “gold standard” for the surgical treatment of endometriomas but is followed by a high recurrence rate. Hormone therapy with gestagens after surgery can reduce the recurrence rate of the disease. When prescribing gestagens, it is necessary to considerer their efficacy, the benefit-risk ratio of different regimens, and individual preferences of patients. Objective. To study the effect of complex treatment including surgery and postoperative gestagen therapy on the recurrence rate of ovarian endometriomas, pain intensity and quality of life in patients. Patients and methods. This prospective longitudinal comparative study included 70 reproductive-aged women with ovarian endometriomas who underwent surgical treatment. The age of patients ranged between 19 and 47 years (mean age – 34.3 ± 7 years). All patients were randomized into three groups. Group I consisted of 26 patients receiving dydrogesterone 20 mg daily in a prolonged cyclical regimen from day 5 to day 25 of the menstrual cycle. Group II included 21 patients receiving dienogest 2 mg daily in a continuous regimen. Group III (control) consisted of 23 patients who did not receive hormone therapy after surgery. The follow-up period lasted for 12 months. The recurrence rate of endometriomas was assessed using transvaginal ultrasound. Pain intensity was determined by a visual analog scale (VAS). The quality of life of patients was evaluated preoperatively and 12 months after surgery using the Endometriosis Health Profile questionnaire (EHP-5). A questionnaire survey was conducted among patients receiving gestagens to determine their satisfaction with the medication. Results. Intraoperatively, endometriomas were detected in 44.3% of cases in the left ovary (n = 31), in 35.7% (n = 25) in the right ovary, and in 20% (n = 14) in both ovaries. Cystectomy for endometriomas was performed. Among 47 patients receiving gestagens, the recurrence rate was 6.4% (n = 3). Among 23 patients in the control group, recurrence occurred in 34.7% (n = 8) (p = 0.004). Among patients receiving dydrogesterone, there were 2 recurrence cases of endometrioma with a diameter of 3 cm, representing 7.7%. With dienogest therapy, recurrence of endometrioma with a diameter of 4 cm was observed in 1 patient (p = 0.6). Group analysis showed that regardless of the type of gestagen, the recurrence rate was significantly lower in complex treatment compared to the control group. After 12 months of dydrogesterone therapy, VAS pain intensity decreased compared to baseline values – from 7.5 [5, 25; 10] cm to 0.5 [0; 2] cm (p < 0.001), respectively, as well as in the dienogest subgroup – from 7 [5; 10] cm to 0 [0; 2.5] cm (p < 0.001). It should be noted that there was no difference in values between the dydrogesterone and dienogest groups (p > 0.05). Uterine bleeding occurred in 4 (19%) patients receiving dienogest, while no uterine bleeding occurred with dydrogesterone. A questionnaire survey conducted in subgroups according to the EHP-5 scale revealed an improvement in the quality of life of patients with endometriosis receiving gestagen therapy. Conclusion. The use of gestagens for 12 months after surgical treatment of endometriosis can significantly reduce the recurrence rate of ovarian endometriomas and pain intensity and improve the quality of life of patients without significant differences in efficacy between the dienogest and dyrogesterone groups. Key words: endometrioma, endometriosis, endometrioma recurrence, dydrogesterone, dienogest, gestagens, EHP-5
POTENTIAL ВIOMARKERS OF ENDOMETRIOSIS: THE SEARCH IS UNDERWAY , ALIYA SH. ZARIPOVA, RUSHANIA I. GABIDULLINA, , FARIDA F. MINNULLINA, , DINARA I. AKHMETOVA, , YURIJ V. ORLOV, and Vestnik Sovremennoi Klinicheskoi Mediciny, 2023 Introduction. Endometriosis is a chronic estrogen-dependent disease characterized by the presence of endometrial-like tissue outside the uterine cavity and most often manifested by pelvic pain and infertility. It affects up to 10% of women of reproductive age, which is about 190 million women worldwide, and it is a serious medical and social issue. In the clinical context, it is advisable to search for biomarkers of the disease to ensure early noninvasive diagnosis. Current literature on potential biomarkers of endometriosis is already quite extensive. However, despite many publications, there is no consensus on and no similar approaches to defining such markers. Therefore, the search for potential biomarkers of endometriosis is still relevant. Aim: To summarize the information of contemporary literature on possible biomarkers of endometriosis that can be used in its early diagnosis and treatment. Materials and Methods. This is a review of publications based on search results in electronic resources in Russian and international systems, such as eLibrary, PubMed, MedLine, Crossref, etc., over the past 8 years (2015-2023). Results and Discussion. A constantly improving palette of the latest technologies that include and combine metabolomics, genomics, and proteomics, can be the key to success in finding reliable biomarkers. For such a complex and heterogeneous disease as endometriosis, a panel of biomarkers is likely to be more accurate than a single marker, both for the diagnosis and probably for helping classify subtypes of the disease. Conclusion. Current literature on potential biomarkers is quite extensive, but the desired result has not been achieved yet. Further research is needed.
ON THE RISKS OF MALIGNISATION OF OVARIAN ENDOMETRIOMAS , RUSHANIA I. GABIDULLINA, FARIDA F. MINNULLINA, , DINARA I. AKHMETOVA, , ALIYA SH. ZARIPOVA, , KAMILYA I. ZIDIHANOVA, , DARYA A. ROOT, and Vestnik Sovremennoi Klinicheskoi Mediciny, 2023 Introduction. Endometriosis is a widespread gynecological disease. In the last few years, new data have been accumulating confirming that endometriosis leads to an increased risk of malignant neoplasms of the ovaries, endometrium, breast and thyroid gland. The most commonly found form of endometriosis is endometrioma. Objective: to analyze epidemiological and genetic studies of the risks of neoplastic transformation of ovarian endometriomas based on search results in electronic resources MEDLINE, EMBASE, Elibrary from 2012 to 2023. Results. Epidemiological and genetic studies have proven the risk of malignancy of endometriosis with the development of ovarian cancer related to endometriosis. Studies confirmed, that two histotypes of epithelial ovarian cancer, such as clear-cell and endometrioid cancer, most closely related to endometriosis. Genome-wide association studies (GWAS) have confirmed the risk of endometrial cancer in women with endometriosis, which was shown earlier than epidemiological studies. Finding the genes and pathways underlying these complex diseases is an essential step toward developing better diagnostic and therapeutic tools. Conclusion. The review presents epidemiological and genetic evidence of the risks of ovarian cancer and endometrial cancer in women with endometriosis.
