Conservative management of endometriosis: follow-up observations of progestin therapy

44 patients treated at the authors clinic from September 1957 to June 1966 were given Enovid therapy after histologic confirmation of endometriosis. In 13 colpotomy biopsy of pelvic lesions was done; in 19 partial ovarian resection; in 4 hysterectomy was needed. Functioni ng ovarian tissue was conserved in all. Therapy consisted of 20 mg Enovid per day for 60-120 days. The dose was increased to 30 or 40 mg daily if breakthrough bleeding occurred. Nausea was the most common complaint. Edema and breast engorgement were common. The age range of patients was 19-48 years. Presenting symptoms were pelvic pain in 30 infertility in 21 dysmenorrhea in 16 dyspareunia in 7 and abnormal bleeding in 6. 20 patients were childless the remaining 24 had an average of 2.08 children. Palpable ovarian tumors or cysts wwere present in 31. Cul-de-sac and uterosacral nodules were present in 27. In 2 cases endometriosis had invaded the bladder and in 1 the sigmoid colon. A fixed retroverted uterus was present in 15. Uterine myomata were present in 10. Only 1 vaginal lesion was found. Follow-up data are available for 41 patients for periods of 3 to 96 months. Palpable nodules regressed or disappeared in 93%. Pelvic pain was relieved in 93% of patients with this symptom. Retreatment was given to 3 patients. In 1 of these who failed to improve a tuboovarian abscess was found. Of the 44 patients 13 had subsequent operations. In only 1 was persistent endometriosis found and that disappeared after a second course of therapy. No serious side-effects of the progestin therapy were noted. Subsequent fertility rate was 33%.