Management of Young Women with Endometriosis after Conservative Laparoscopic Surgery

Objective: To evaluate the management of young women with endometriosis after conservative laparoscopic surgery.Design: Retrospective study.Setting: Department of Obstetrics and Gynecology, Kochi Medical School.Patients: Sixty-four women aged < 30 years, diagnosed and treated for endometriosis by laparoscopic surgery.Interventions: Laparoscopic evaluation and treatment of endometriosis.Main outcome measures: Background of 64 women with endometriosis who were less than 30 years old: (1) Recurrence rate (RR) of pelvic pain associated endometriosis in 62 women had pelvic pain before laparoscopic surgery; (2) Recurrence rate (RR) of ovarian endometriomas in 42 women who underwent laparoscopic excision or ablation of ovarian endometriomas. Furthermore, fertility prognosis for 14 women who desired a pregnancy was assessed.Results: The median age was 25.2 years (range: 16-29 years); the median duration of postoperative follow-up was 3.3 years (range: 1-152 months) surgery. Nineteen women (30%) were categorized at rASRM stageI-II, and 45 women (70%) were at stage III-IV. After surgery, 34 women underwent medical therapy for the prevention of endometriosis recurrence; 23 were administered a GnRH agonist, and 11 received oral contraceptives (OCs). RR of pelvic pain was 16%, and RR of an ovarian endometrioma was 24%. None of the women who received OCs experienced a recurrence. In 14 women who were desirous of pregnancy, 10 achieved a spontaneous pregnancy within two years of marriage.Conclusions: The results suggested that postoperative medical treatment with OCs prevents the recurrence of endometriosis and pelvic pain in young women; the therapy also prevents the formation of ovarian endometriomas. In addition, laparoscopic surgery for endometriosis did not impair the fertility of young women with endometriosis.