Concomitant endometriosis and leiomyoma in women of reproductive age

М. Б. Запорожченко, А. В. Сидоренко, Д. Ю. Парубина

Abstract


Endometriosis and leiomyoma commonly co-exist inside one uterus. Specialized surgical centers report detection frequency of comorbid endometriosis during surgery or laparoscopy that varies from 20 to 87% in patients with symptomatic fibroids.

In authors practice the histological study of surgery samples from patients diagnosed with symptomatic fibroids (113 hysterectomies) revealed concomitant endometriosis in 26.5% cases.

Clinical and morphological analysis showed that in patients with multiply fibroids, large volumes or submucous myomas comorbid adenomyosis doesn’t interfere significantly with the clinic course. But in cases of small-size solitary intramural or subserosis fibroids the clinic of symptomatic myomas is determined by the comorbid adenomyosis of diffuse-nodular or diffuse-lesion forms and 2–3 stages.

Thus, endometriosis associated with leiomyomas causes more severe course of comorbidity. Patients with symptomatic fibroids are exposed to higher risk of endometriosis development, which must be kept in mind when planning the surgery treatment. Authors propose to enhance laparoscopic myomectomy with target revision of pelvis to reveal possible endometriosis, because laparoscopy provides the best opportunity to visualization of endometriosis lesions.

The choice of pharmacotherapy of concomitant uterine pathology is limited. Gonadotropin-releasing hormone agonists is the only currently available group of drugs that labeled both for the treatment of endometriosis and fibroids. Selective progesterone-receptor modulator ulipristal acetate due to its unique antiproliferative and selective proapoptotic effect on the leiomyomas cellular component is very promising in the uterine-sparing therapy of myomas. In addition, it has pharmacodynamic effects on the endometrium, including antiproliferative effects that may contribute to the treatment of endometriosis. Clinical trial of ulipristal on this indication is ongoing (NCT02213081). For the present, in the absence of approved algorithms for the treatment of co-morbid pathology, the individual approach with combining preparations of different classes is relevant.


Keywords


uterine myoma; endometriosis; comorbidity; surgical treatment; pharmacotherapy; ulipristal acetate

References


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Ulipristal for Endometriosis-related Pelvic Pain, clinical trial. Available from: [http://clinicaltrials.gov], identifier: NCT02213081. Last accessed Sep 1, 2017.


GOST Style Citations


1. Borah, B.J., Nicholson, W.K., Bradley, L., Stewart, E.A. “The impact of uterine leiomyomas: a national survey of affected women.” Am J Obstet Gynecol 209.4 (2013): 319.e1–20.

2. Stewart, E.A. “Uterine fibroids.” Lancet 357 (2001): 293–8.

3. Rackow, B.W., Arici, A. “Fibroids and in-vitro fertilization: which comes first?” Curr Opin Obstet Gynecol 17 (2005): 225–31.

4. Nezhat, C., Nezhat, F., Nezhat, C. “Endometriosis: ancient disease, ancient treatments.” Fertil Steril 98. Suppl 6 (2012): S1–62.

5. Gruppo italiano per lo studio dell’endometriosi. “Prevalence and anatomical distribution of endometriosis in women with selected gynaecological conditions: results from a multicentric Italian study.” Hum Reprod 9.6 (1994): 1158–62.

6. Uimari, O., Järvelä, I., Ryynänen, M. “Do symptomatic endometriosis and uterine fibroids appear together?” J Hum Reprod Sci 4.1 (2011): 34–8.

7. Nezhat, C., Li, A., Abed, S. “Strong Association Between Endometriosis and Symptomatic Leiomyomas.” JSLS 20.3 (2016). DOI: 10.4293/JSLS.2016.00053

8. American Society for Reproductive Medicine. “Revised American Society for Reproductive Medicine classification of endometriosis.” Fertil Steril 67.5 (1996): 817–21.

9. Corona, L.E., Swenson, C.W., Sheetz, K.H., et al. “Use of other treatments before hysterectomy for benign conditions in a statewide hospital collaborative.” Am J Obstet Gynecol 212.3 (2015): 304.e1–7. DOI: 10.1016/j.ajog.2014.11.031

10. Carranza-Mamane, B., Havelock, J., Hemmings, R.; Reproductive endocrinology and infertility committee; Special Contributor. “The management of uterine fibroids in women with otherwise unexplained infertility.” J Obstet Gynaecol Can 37.3 (2015): 277–85.

11. Vercellini, P., Eskenazi, B., Consonni, D., et al. “Oral contraceptives and risk of endometriosis: a systematic review and meta-analysis.” Hum Reprod Update 17.2 (2011): 159–70.

12. D’Arpe, S., Di Feliciantonio, M., Candelieri, M., et al. “Ovarian function during hormonal contraception assessed by endocrine and sonographic markers: a systematic review.” Reprod Biomed Online 33.4 (2016): 436–48.

13. Резолюція експертної ради. Сучасні підходи до хірургічного та постхірургічного медикаментозного ведення пацієнток із ендометріозом // Репродуктивна ендокринологія. – 2017. – №2 (34). – C. 8–10.

14. Kim, J.J., Sefton, E.C. “The role of progesterone signaling in the pathogenesis of uterine leiomyoma.” Mol Cell Endocrinol 358.2 (2012): 223–31.

15. Lethaby, A., Vollenhoven, B., Sowter, M. “Pre-operative GnRH analogue therapy before hysterectomy or myomectomy for uterine fibroids.” Cochrane Database Syst Rev (2001): CD000547.

16. Stovall, T.G., Muneyyirci-Delale, O., Summit, R.L. Jr., Scialli, A.R.

“GnRH agonist and iron versus placebo and iron in the anemic patient before surgery for

leiomyomas: a randomized controlled trial.” Obstet Gynecol 86 (1995): 65–71.

17. Gainer, E.E., Ulmann, A. “Pharmacologic properties of CDB(VA)-2914.” Steroids 68 (2003): 1005–11.

18. Yoshida, S., Ohara, N., Xu, Q., et al. “Celltype specific actions of progesterone receptor modulators in the regulation of uterine leiomyoma growth.” Semin Reprod Med 28 (2010): 260–73.

19. Spitz, I.M. “Clinical utility of progesterone receptor modulators and their effect on the endometrium.” Curr Opin Obstet Gynecol 21 (2009): 318–24.

20. Donnez, J., Tatarchuk, T.F., Bouchard, P., et al.; PEARL I Study Group. “Ulipristal acetate versus placebo for fibroid treatment before surgery.” N Engl J Med 366 (2012): 409–20.

21. Donnez, J., Tomaszewski, J., Vázquez, F., et al.; PEARL II Study Group. “Ulipristal acetate versus leuprolide acetate for uterine fibroids.” N Engl J Med 366 (2012): 421–32.

22. Donnez, J., Donnez, O., Matule, D., et al. “Long-term medical management of uterine fibroids with ulipristal acetate.” Fertil Steril 105.1 (2016): 165–73. e4.

23. Ulipristal for Endometriosis-related Pelvic Pain, clinical trial. Available from: [http://clinicaltrials.gov], identifier: NCT02213081. Last accessed Sep 1, 2017.





DOI: https://doi.org/10.18370/2309-4117.2017.36.24-30

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