Concomitant endometriosis and leiomyoma in women of reproductive age
Keywords:uterine myoma, endometriosis, comorbidity, surgical treatment, pharmacotherapy, ulipristal acetate
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.
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