Assessment of 25(OH)D status in patients with genital endometriosis and clinical efficacy of cholecalciferol in the treatment of the disease

Abstract

AIM: The aim of this study was to determine the 25(OH)D status in patients with genital endometriosis compared to the control group and to analyze the clinical efficacy of cholecalciferol implication as a combined targeted therapy of the disease.

MATERIALS AND METHODS: The main group included 440 patients with genital endometriosis (mean age 33.7±5.8 years) with various degrees of disease prevalence. The control group consisted of 30 women with the normal ovulatory menstrual cycle (mean age 26.3±3.1 years) in whom gynecological pathology was not revealed. Peripheral blood (PB) 25(OH)D level was assessed in all the participants included into the study. In 49 women from the main group, the level of 25(OH)D in the peritoneal fluid (PF) was determined. Comparative evaluation of the clinical efficacy of cholecalciferol intake in combination with gonadotropin-releasing hormone agonist (aGnRH) 3.75 mg injections or with dienogest 2 mg oral administration, as well as monotherapy in comparison with standard hormone-modulating treatment was carried out. Prior to the start of treatment, the patients had pain syndrome of varying severity, which was evaluated using the McGill Pain Questionnaire with the Visual Analogue Scale for pain. The psycho-emotional status was assessed using the Hospital Anxiety and Depression Scale. The Excel, Statistica 10, and Jamovi software programs were used to process the obtained data.

RESULTS: The level of 25(OH)D in PB of patients with endometriosis was significantly lower compared to the control group (p < 0.001). Women with Grades III and IV genital endometriosis were characterized by lower PB 25(OH)D levels compared to the patients with Grades I and II of the disease, but the difference was not statistically significant. Relationships were revealed between 25(OH)D levels in the PB and PF (p < 0.001), as well as PF 25(OH)D level and the disease prevalence (p = 0.004). Significantly more pronounced pain reduction and stabilization of the psycho-emotional status were observed in patients receiving combined therapy with cholecalciferol.

CONCLUSIONS: Insufficient level of vitamin D and vitamin D deficiency can be considered as factors that play a role in the progression of genital endometriosis. The use of cholecalciferol in combination with aGnRH 3.75 mg or dienogest 2 mg may more effectively reduce the severity of pain and stabilize the psycho-emotional status in patients with genital endometriosis compared to standard hormone-modulating therapy.

Keywords

vitamin D / 25(OH)D / cholecalciferol / peritoneal fluid / genital endometriosis

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