Modern progestogens in the treatment of genital endometriosis

Abstract

Objective of the review: to evaluate modern approaches to the use of progestogens for the treatment of endometriosis, using literature sources, to provide examples of their effectiveness in global and own practices. Analysis of literary data. In total, 41 publications by foreign authors were selected and processed. Information on the effectiveness of the domestic progestogen drug Vigest-KV in the treatment of endometriosis in our own practice is also presented. Today, the newest progestin is dienogest, a derivative of 19-nortestosterone. It has shown its high efficiency in various clinical manifestations of endometriosis, as well as in its recurrences. Long-term treatment regimens with dienogest (60 months) are promising, as they effectively reduce pain and the risk of endometriosis recurrence, in particular after surgical treatment. An important advantage of dienogest is the low frequency of side effects (1.2–2.5%), especially such as the effect on bone mineral density. Our clinical experience allows us to recommend the Ukrainian medicinal product Vigest-KV, containing dienogest, for the treatment of various types of endometriosis. Its advantage is a special mechanism of ovulation blockade aimed at apoptosis of the granulosa cells of the growing follicle. Also, long-term use of this drug leads to the inhibition of follicle-stimulating and luteinizing hormones and a moderate decrease in the estradiol, the level of which is within the physiological parameters. This is very important to avoid the symptoms of estrogen deficiency while maintaining the anti-proliferative effect. Conclusions. Today, the main method of treating endometriosis is hormone therapy. It not only reduces the clinical symptoms of endometriosis, but is also used before and after surgical treatment to reduce the risk of disease recurrence. Progestins (dienogest) are the most common hormonal method of treating endometriosis. Dienogest, as the most effective progestin, has a pronounced anti-proliferative effect directed at the endometrium, as well as anti-inflammatory and immunomodulatory effects with a minimal risk of side effects. Dienogest in a dose of 2 mg/day provides a reduction in clinical symptoms, an improvement in the quality of life and preservation of reproductive function. Taking into account our own clinical experience of using Vigest-KV in various types of endometriosis, we can recommend its implementation into clinical practice.

Keywords

• endometriosis
• progestins
• dienogest
• vigest-kv