Endometriosis

Main article: Gynecology

The disease has been known since the 70s of the XIX century. The causes of endometriosis by scientists have not yet been studied. Abnormal endometrial cells spread through the body along with blood and lymphoma - in which the disease is similar to cancer. But, unlike cases of oncology, the new nodes of endometriosis formed are benign in nature. Endometriosis can affect any organs: from the uterus, ovaries, fallopian tubes and intestines to the lungs, conjunctiva of the eyes and the internal cavity of the nose.

Spread of the disease

2022:190 million women of reproductive age in the world have endometriosis

As of 2022, more than 190 million women of reproductive age have endometriosis, according to the World Health Organization.

2018:187 million women in the world with endometriosis

For 2018, one in ten women in the world is sick with endometriosis, or 187 million people aged 15 to 49 years. By 2025, this number will grow by 5.3%, to 196.6 million, according to a report by the British research agency Research and Markets. This disease is in third place in the prevalence of gynecological pathologies. In every fifth case, endometriosis is the cause of infertility.

2016:155 for every 100 thousand women in Russia first learned that they had endometriosis

In Russia, according to Rosstat, in 2016, 155 out of 100 thousand women were first diagnosed, while in 2015 - 142 out of 100 thousand women, the data for 2017 are being specified, but, according to experts, do not exceed last year's indicators. Nevertheless, many researchers believe that there are more real cases of endometriosis. The disease often proceeds in a latent form and is difficult to diagnose. So, in Europe, from the moment the first symptoms are detected to the diagnosis of "endometriosis," 6-7 years pass, and in Russia - 12 years.

The course of the disease

The disease significantly reduces the quality of life: 6 out of 10 women experience severe pain, and 30-50% face problems with conception.

Among the main clinical manifestations of the disease are infertility, problems of miscarriage, impaired cycle, including amenorrhea or heavy menstrual bleeding, as well as pronounced pain syndrome.

The development of endometriosis is accompanied by a chronic inflammatory reaction associated with the presence of a large amount of low molecular weight hyaluronic acid, which contributes to the initiation of fibrotic processes and the formation of adhesions, and additionally stimulates inflammation.

"In almost 60% of cases, women suffering from endometriosis face a adhesion process in the pelvis. Adhesions can appear both de novo and occur after surgical treatment. Adhesive process leads to the shift of bodies in a small basin and their fixing in atypical situation - such situation and provokes developing of painful chronic pelvic pain", - Maria Igorevna Yarmolinskaya, professor of RAS, MD, the head of department of gynecology and endocrinology of FGBNU of "scientific research institute of obstetrics, gynecology and a reproduktologiya of D.O. Ott" said in 2025.

Impact on the psyche

Endometriosis destroys the psyche of women stronger than HIV and cancer. Such conclusions were reached by Australian scientists from Monash University in Melbourne as a result of a study of the impact of endometriosis on women's lives. In a survey of 500 respondents, the researchers found that 86.5% of them have symptoms of depression, and 87.5% of women found an alarming condition. The strongest demotivating factors that negatively affect the psychological state of women are the inability to control the course of the disease, severe pain and inadequate condition during attacks. Because of this, patients have reduced social and personal activity, the disease deprives them of optimism and confidence in the future.

Endometriosis greatly affects the daily life of women, according to a report by scientists published the other day in the journal Health Care for Women International. The greatest discomfort causes pain - the surveyed women rated this indicator in the range from 40 to 50 points. Also, the psychological state is influenced by the uncontrollability of attacks of the disease and its course - 40-60 points, negative emotions and experiences (40-47 points), lack of social support (39-50 points). Such an indicator as a drop in self-esteem due to its inability to "fit" into the generally accepted behavioral framework in society and sharp "failures" in career and professional plans, received from 36 to 43 points. These findings suggest the impact of endometriosis on women's lives has a more devastating impact than diagnoses such as HIV or cancer, Melbourne researchers note.

Endometriosis has the greatest impact on young women aged 18-25, Australian scientists note. At this time, many different changes occur in a woman's life and the foundations of a prosperous future are laid. Endometriosis deprives them of the opportunity to enter into personal relationships, plan a family and children. According to the ESHRE (European Society of Human Reproduction and Embryology) study, 75.4% of women surveyed with endometriosis periodically experience depressive conditions or severe anxiety associated with difficulties in partnerships and intimate relationships.

Treatment

2025: Tackling antibiotic-blocking biofilms

For 2025, doctors are fighting biofilms, structures that unite a large number of microorganisms, and significantly increase their survival rate.

"Biofilm is a kind of microbiological evolutionary arms race. This is an adaptable mechanism that allows bacteria to survive in difficult conditions. Complex therapy allows to overcome biofilms, which today should be given special attention, "said Alexey Alekseevich Khryanin, Doctor of Medical Sciences, Professor in 2025.

The problem of biofilm formation in gynecology is very common: from 52 to 96.7% of inflammatory diseases of the pelvic organs are accompanied by their formation. Bacteria found in biofilms survive in the presence of high concentrations of antibiotics, which makes it difficult to fight inflammation. Chronic inflammation can provoke chronic pelvic pain, stimulate the adhesion process. Biofilm destruction is therefore a key factor in effective therapy of inflammatory diseases.

With salpingoophoritis, biofilms are formed in 40-60% of patients, therefore, for the successful treatment of antibacterial therapy alone, said Guldana Raufovna Bayramova, MD, Professor of the Department of Obstetrics and Gynecology, Department of Professional Education, FSBI National Medical Research Center of the AGP named after V.I. Kulakova Ministry of Health of Russia. According to her, to achieve a therapeutic effect, a combined treatment is necessary: an antibiotic plus drugs that destroy the biofilm matrix, in particular, based on hyaluronidase.

Chronic inflammation and biofilms are a barrier to pregnancy. The treatment of chronic endometritis plays a key role in the implementation of reproductive function, because even with a good embryo, implantation will not take place if the endometrium is affected by chronic inflammation and biofilms, explained Natalya Igorevna Tapilskaya, Doctor of Medical Sciences, Professor, Head of the Department of Gynecology and Endocrinology of the Federal State Budgetary Institution "NIIAGiR named after D.O. Otta," Professor of the Department of ObstEtrics and Gynecology. She emphasized that in order to restore the full receptivity of the endometrium, antibiotics must be combined with adjuvant therapy that can destroy biofilms.

2018: Patients in Russia spend about 50 billion rubles a year on treatment

For 2018, there is no single method of treating endometriosis: in each specific case, its own scheme is selected. The most effective combination therapy, including surgery followed by medical treatment. It is impossible to completely cure the disease. In 21% of cases, relapses occur 1-2 years after surgery, in 47% of cases - 5 years, and in 57% of cases - 7 years.

The largest part of the cost of treatment falls on the patient. Within the framework of the state budget, only 780 million rubles are allocated to help patients with endometriosis, and patients spend about 50 billion rubles a year on medicines on their own. According to the DSM Group report, the average cost of packaging drugs for the treatment of urogenital diseases in 2016 amounted to 550 rubles.

"The main problem with endometriosis therapy is duration. In order to maintain reproductive function and minimize the risks of relapse, patients must take medication for months, or even years. Here, a very important point is the optimal selection of therapy, which allows you to maximally suppress the growth of endometriosis foci and restore the reproductive function of a woman, - say the pharmaceutical company Nativa. - Currently, gonadotropin-releasing hormone agonists meet these requirements to a greater extent. They quickly relieve pain syndrome, reduce endometrioid foci, prevent relapses and help restore a woman's fertility. "

Such drugs are produced by many pharmaceutical companies, including the Russian manufacturer Nativa, the company comments.