Aspiration (sclerosing) therapy of ovarian endometriomas: possibilities, prospects, long-term outcomes

Gynecology, Obstetrics and Perinatology - Gynecology, Obstetrics and Perinatology - 2018 volume 17 issue 1 Aspiration (sclerosing) therapy of ovarian endometriomas: possibilities, prospects, long-term outcomes Authors / Institutions Aleksandr I. Davydov / Marina B. Tairova / Marina N. Shakhlamova / The objective. To study the effectiveness and long-term outcomes of sclerotherapy for ovarian endometriomas and to substantiate the conditions and indications for minimally invasive intervention. Patients and methods. We analysed 124 interventions performed by the technique of aspiration (sclerosing) therapy of endometrioid ovarian cysts. The patients’ age varied from 18 to 42 years, averaging 26.4 ± 4.2 years. The mean diameter of ovarian endomeriomas varied from 25 to 65 mm. In 84 (67.7%) of observations, pathological process was unilateral, in 72.3% – bilateral. 43 (34.6%) women had disease recurrence after previously performed cystectomy, in 28 (22.6%) endometrioid cysts were located in the only ovary and in 7 (5.6%) patients ultrasonography found that the ovary contralateral to endometrioid tumour was sharply decreased and its sections lacked the signs of antral follicles after preceding cystectomy. In fact, in 35 (28.2%) patients endometrioma was diagnosed in the only ovary. All patients after aspiration therapy of endometriomas received dienogest (2 mg) + ethinylestradiol (0.03 mg) (Siluette®, «Gedeon Richter»). Results. The recurrence rate of endometriomas during the first 12 months of follow-up was 38.7%, during the first 3 months of follow-up this parameter did not exceed 9.7%. Within 7–12 months after intervention spontaneous pregnancy occurred in 36.3% (46) of women, ending with childbirth in all cases (with the use of contraception 25 patients – 46%). Conclusion. Sclerotherapy of ovarian endometriomas with ultrasound monitoring of intervention is a minimally invasive method of treating women of reproductive age, ensuring preservation of ovarian reserve. It is not a monotherapy, its outcome is in many respects determined by the adequacy of postoperative hormonal treatment. Key words: dienogest+ethinylestradiol, sclerotherapy, recurrence rate, endometrioma. For citation: Davydov A.I., Tairova M.B., Shakhlamova M.N. Aspiration (sclerosing) therapy of ovarian endometriomas: possibilities, prospects, long-term outcomes. Vopr. ginekol. akus. perinatol. (Gynecology, Obstetrics and Perinatology). 2018; 17(1): 13–21. DOI: 10.20953/1726-1678-2018-1-13-21 Patients and methods. We analysed 124 interventions performed by the technique of aspiration (sclerosing) therapy of endometrioid ovarian cysts. The patients’ age varied from 18 to 42 years, averaging 26.4 ± 4.2 years. The mean diameter of ovarian endomeriomas varied from 25 to 65 mm. In 84 (67.7%) of observations, pathological process was unilateral, in 72.3% – bilateral. 43 (34.6%) women had disease recurrence after previously performed cystectomy, in 28 (22.6%) endometrioid cysts were located in the only ovary and in 7 (5.6%) patients ultrasonography found that the ovary contralateral to endometrioid tumour was sharply decreased and its sections lacked the signs of antral follicles after preceding cystectomy. In fact, in 35 (28.2%) patients endometrioma was diagnosed in the only ovary. All patients after aspiration therapy of endometriomas received dienogest (2 mg) + ethinylestradiol (0.03 mg) (Siluette®, «Gedeon Richter»). Results. The recurrence rate of endometriomas during the first 12 months of follow-up was 38.7%, during the first 3 months of follow-up this parameter did not exceed 9.7%. Within 7–12 months after intervention spontaneous pregnancy occurred in 36.3% (46) of women, ending with childbirth in all cases (with the use of contraception 25 patients – 46%). Conclusion. Sclerotherapy of ovarian endometriomas with ultrasound monitoring of intervention is a minimally invasive method of treating women of reproductive age, ensuring preservation of ovarian reserve. It is not a monotherapy, its outcome is in many respects determined by the adequacy of postoperative hormonal treatment. Key words: dienogest+ethinylestradiol, sclerotherapy, recurrence rate, endometrioma. For citation: Davydov A.I., Tairova M.B., Shakhlamova M.N. Aspiration (sclerosing) therapy of ovarian endometriomas: possibilities, prospects, long-term outcomes. Vopr. ginekol. akus. perinatol. (Gynecology, Obstetrics and Perinatology). 2018; 17(1): 13–21. DOI: 10.20953/1726-1678-2018-1-13-21