Romanovskaya Anna Viktorovna (MD, Head of the Department of Obstetrics and Gynecology at the Faculty of Medicine, Director of the Clinic of Obstetrics and Gynecology, Chief Freelance Gynecologist at the Ministry of Health of the Saratov Region,
Saratov State Medical University named after V. I. Razumovsky of the Ministry of Health of the Russian Federation
)
Arzhaeva Inga Arkadievna (Candidate of Medical Sciences, Associate Professor of the Department of Obstetrics and Gynecology, Faculty of Medicine
Saratov State Medical University named after V. I. Razumovsky of the Ministry of Health of the Russian Federation
)
Parshin Alexey Vladimirovich (Candidate of Medical Sciences, Associate Professor of the Department of Obstetrics and Gynecology, Faculty of Medicine,
Saratov State Medical University named after V. I. Razumovsky of the Ministry of Health of the Russian Federation
)
Mikhailova Anastasia Vladimirovna (Assistant of the Department of Obstetrics and Gynecology, Faculty of Medicine
Saratov State Medical University named after V. I. Razumovsky of the Ministry of Health of the Russian Federation
)
Klassov Alibek Murzabekovich (Saratov State Medical University named after V. I. Razumovsky of the Ministry of Health of the Russian Federation )
Nemtseva Lada Andreevna (Saratov State Medical University named after V. I. Razumovsky of the Ministry of Health of the Russian Federation )
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Endometriosis remains one of the most complex gynecological
diseases, requiring a comprehensive approach to treatment. Modern
studies demonstrate the limited effectiveness of monotherapeutic
strategies and the need to develop optimal combined regimens. The
aim of the present study was to assess the effectiveness and safety of
various combinations of hormonal and anti-inflammatory therapy in
patients with confirmed endometriosis stages III–IV. In a prospective
cohort study, 238 reproductive-age patients were enrolled and divided
into three groups depending on the therapy received: dienogest in
combination with NSAIDs, GnRH agonists with add-back therapy in
combination with NSAIDs, and GnRH agonists with add-back therapy
combined with aromatase inhibitors. The effectiveness of the therapy was
evaluated by the dynamics of pain syndrome, quality of life, frequency
of recurrences, and the occurrence of pregnancy during 24 months of
follow-up. The results showed a statistically significant advantage of the
third therapy regimen in terms of reducing pain intensity (reduction of
87.4 % compared to 65.7 % and 71.2 % in the first and second groups,
respectively, p<0.001), improving quality of life (increase on EQ-5D by
0.32±0.07, p<0.001), and reducing the frequency of recurrences (8.3 %
compared to 25.4 % and 17.9 %, p=0.008). The rate of spontaneous
pregnancy was also higher in the third group (32.4% compared to 18.6 %
and 23.8 %, p=0.041). The results obtained indicate the promise of
using multi-component therapy regimens in patients with severe forms
of endometriosis; however, further research is needed in the context of
long-term safety and cost-effectiveness.
Keywords:endometriosis, combined therapy, dienogest, GnRH agonists,
aromatase inhibitors, pain syndrome, fertility
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Citation link:
Romanovskaya A. V., Arzhaeva I. A., Parshin A. V., Mikhailova A. V., Klassov A. M., Nemtseva L. A. EFFICACY OF COMBINED THERAPY IN THE TREATMENT OF ENDOMETRIOSIS: A PROSPECTIVE COHORT STUDY // Современная наука: актуальные проблемы теории и практики. Серия: Естественные и Технические Науки. -2025. -№06/2. -С. 274-282 DOI 10.37882/2223-2966.2025.06-2.31 |
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