Миома матки: новые и перспективные варианты медикаментозного лечения

В обзоре представлены сведения о возможностях терапии миомы матки – доброкачественной опухоли, происходящей из миометрия, которая является наиболее распространенной доброкачественной опухолью малого таза, а также наиболее частым показанием к операции у женщин. Миома матки, как правило, вызывает аномальное маточное кровотечение, симптомы, связанные с давлением, выкидыши и в некоторых случаях бесплодие. Аномальное маточное кровотечение (меноррагия и метроррагия) является основной причиной, по которой женщины обращаются для лечения миомы и основной причиной хирургического вмешательства. В статье проанализированы сведения о медикаментозном лечении миомы матки в сравнительном аспекте. В качестве медикаментозного лечения первыми были предложены гестагены и их комбинации с эстрогеном, которые не продемонстрировали надежной эффективности. Позже была обнаружена очевидная польза применения агонистов/антагонистов гонадотропинрилизинг-гормона, которые вызывают эффект «центральной» химической кастрации, и поэтому их использование ограничено 6 месяцами, и они с успехом используются для подготовки пациенток к операции. Недавно предложены непептидные, перорально активные антагонисты рецепторов гонадотропин-рилизинг-гормона, которые находятся на ранних стадиях клинических испытаний. Однако изменения лекарственной формы и пути введения препаратов, тормозящих активность гонадотропин-рилизинг-гормона, не улучшают профиль их безопасности. Очередным прорывом в терапии миомы матки стало использование селективных модуляторов рецепторов прогестерона, которые ранее называли «антипрогестинами». Препараты данной группы обладают сравнимой с антагонистами гонадотропин-рилизинг-гормона эффективностью и лучшей переносимостью, что делает возможным длительное лечение миомы матки, особенно у женщин в пременопаузе, с помощью этих препаратов.

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