Pharmacological management of dysmenorrhea in women with endometriosis

Dismenoreja je bol podrijetlom iz maternice. Učestalost je visoka, od 45 do 90% kod žena reprodukcijske dobi. Najveća učestalost je u najosjetljivijoj dobnoj skupini. . Negativno utječe na kvalitetu života. Dijeli se na primarnu (bez prisutne organske lezije) te sekundarnu dismenoreju ( povezana s nekom patologijom). Najčešći uzrok sekundarne dismenoreje je endometrioza, kronično stanje koje zahvaća oko 6-10% žena reprodukcijske dobi. Patofiziologija bolesti još uvijek nije razjašnjena. Dijagnoza se postavlja na temelju simptoma i slikovnih pretraga, a zlatni standard je PHD. Terapija je medikamentozna ili kirurška. Dostupne su hormonske i nehormonske metode liječenja i obje se koriste za kontrolu boli i zaustavljanje širenja endometrijskih lezija. Kontracepcijske pilule, NSAR, GnRH agonisti, inhibitori aromataze su neki od najčešće upotrebljavanih lijekova. Istraživanjem patofiziologije endometrioze razvijaju se nove strategije liječenja kao što su selektivni modulatori progesteronskih receptora, antiangiogenetski faktori i imunomodulatori. Ženama koje ne odgovaraju na terapiju lijekovima ili imaju jače izražene simptome, pomaže jedino kirurška ekscizija lezija i histopatološka potvrda dijagnoze.Dysmenorrhea is a pain originating from the uterus. The incidence is high, ranging from 45 to 90% in women of reproductive age. The highest frequency is in the most sensitive age group. It affects negatively on the quality of life. It is divided into primary (no organic lesion present) and secondary dysmenorrhea (associated with some pathology). The most common cause of secondary dysmenorrhea is endometriosis, a chronic condition that affects about 6-10% of women of reproductive age. The pathophysiology of the disease is still unclear. Diagnosis is made based on symptoms and imaging tests, and the gold standard is PHD. Therapy is medical or surgical. Hormonal and non-hormonal methods of treatment are available, and both are used to control pain and stop the spread of endometrial lesions. Birth control pills, NSAIDs, GnRH agonists, aromatase inhibitors are some of the most used drugs. With the discovery of new molecules involved in endometriosis, new treatment strategies are being developed such as selective progesterone receptor modulators, antiangiogenic factors and immunomodulators. Women who do not respond to drug therapy or have more severe symptoms are helped only by surgical excision of the lesions and histopathological confirmation of the diagnosis