Medical Management of Ovarian Endometriomas: A Systematic Review and Meta-analysis

Alexa Eberle, Eberle A, Nguyen DB, Dong Bach Nguyen, Jessica Papillon‐Smith, Jessica Papillon Smith, Smith JP, Fady W Mansour, Mansour FW, Fady Mansour, Srinivasan Krishnamurthy, Krishnamurthy S, Andrew Zakhari, Zakhari A
Obstetrics and gynecology · 2023 · vol. 143(1) , pp. 53–66 · doi:10.1097/aog.0000000000005444 · PMID:37944155 · W4388518876
Systematic review / meta-analysis OA: closed CC0 ⤵ 12 in-corpus citations
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Dienogest, oral contraceptive pills, GnRH agonists, norethindrone acetate, norethindrone acetate with aromatase inhibitor, and danazol were found to significantly reduce ovarian endometrioma size in a systematic review and meta-analysis.

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This systematic review and meta-analysis evaluated the efficacy of various medical interventions in reducing the size of ovarian endometriomas. The researchers analyzed data from thirty-three eligible studies, assessing changes in cyst diameter and volume following treatment with agents such as dienogest, oral contraceptive pills, GnRH agonists, norethindrone acetate, danazol, and combinations involving aromatase inhibitors. The results demonstrated that all tested medical therapies significantly decreased both the diameter and volume of endometriomas compared to baseline measurements. This paper is centrally about endometriosis — specifically the medical management of ovarian endometriomas, a common manifestation of the disease.

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Abstract

OBJECTIVE: To estimate the effect of medical management on the size of ovarian endometriomas. DATA SOURCE: Online databases were searched from inception to October 2022, including Ovid MEDLINE, Ovid EMBASE, PubMed, EBM Reviews-Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov , and Web of Science. METHODS OF STUDY SELECTION: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we included all English-language, full-text articles that reported on change in endometrioma size (either diameter or volume) after medical interventions. Studies evaluating surgical interventions or postoperative recurrence were excluded. All screening and data extraction were performed independently by two authors. Risk of bias assessment was performed with either the Cochrane Risk of Bias Tool for randomized controlled trials or a modified Newcastle-Ottawa Scale for observational studies. TABULATION, INTEGRATION, AND RESULTS: After removal of duplicates, 9,332 studies were screened, with 33 full-text articles deemed eligible for inclusion. In the meta-analysis, dienogest showed significant reduction in cyst diameter (reduction 1.32 cm, 95% CI, 0.91-1.73, eight studies, n=418 cysts) and volume (mean difference of log-transformed volume 1.35, 95% CI, 0.87-1.83, seven studies, n=282 cysts). Similarly, significant reductions were seen with the oral contraceptive pill (OCP) (1.06 cm, 95% CI, 0.59-1.53, nine studies, n=455), gonadotropin-releasing hormone (GnRH) agonists (1.17 cm, 95% CI, 0.42-1.92, four studies, n=128 cysts), norethindrone acetate (0.6 cm, 95% CI, 0.27-0.94, two studies, n=88 cysts), and danazol (1.95 cm, 95% CI, 1.18-2.73, two studies, n=34 cysts). Norethindrone acetate with aromatase inhibitor was also effective in reducing endometrioma volume (mean difference of log-transformed volume 1.47, 95% CI, 0.16-2.78, two studies, n=34 cysts). CONCLUSION: Medical management with dienogest, OCPs, GnRH agonists, norethindrone acetate, norethindrone acetate with aromatase inhibitor, or danazol can reduce the size of ovarian endometriomas. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD 42022363319.
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Objective

To estimate the effect of medical management on the size of ovarian endometriomas. DATA SOURCE: Online databases were searched from inception to October 2022, including Ovid MEDLINE, Ovid EMBASE, PubMed, EBM Reviews—Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and Web of Science.

Methods

OF STUDY SELECTION: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we included all English-language, full-text articles that reported on change in endometrioma size (either diameter or volume) after medical interventions. Studies evaluating surgical interventions or postoperative recurrence were excluded. All screening and data extraction were performed independently by two authors. Risk of bias assessment was performed with either the Cochrane Risk of Bias Tool for randomized controlled trials or a modified Newcastle-Ottawa Scale for observational studies. TABULATION, INTEGRATION, AND RESULTS: After removal of duplicates, 9,332 studies were screened, with 33 full-text articles deemed eligible for inclusion. In the meta-analysis, dienogest showed significant reduction in cyst diameter (reduction 1.32 cm, 95% CI, 0.91–1.73, eight studies, n=418 cysts) and volume (mean difference of log-transformed volume 1.35, 95% CI, 0.87–1.83, seven studies, n=282 cysts). Similarly, significant reductions were seen with the oral contraceptive pill (OCP) (1.06 cm, 95% CI, 0.59–1.53, nine studies, n=455), gonadotropin-releasing hormone (GnRH) agonists (1.17 cm, 95% CI, 0.42–1.92, four studies, n=128 cysts), norethindrone acetate (0.6 cm, 95% CI, 0.27–0.94, two studies, n=88 cysts), and danazol (1.95 cm, 95% CI, 1.18–2.73, two studies, n=34 cysts). Norethindrone acetate with aromatase inhibitor was also effective in reducing endometrioma volume (mean difference of log-transformed volume 1.47, 95% CI, 0.16–2.78, two studies, n=34 cysts).

Conclusion

Medical management with dienogest, OCPs, GnRH agonists, norethindrone acetate, norethindrone acetate with aromatase inhibitor, or danazol can reduce the size of ovarian endometriomas. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD 42022363319. Dienogest, oral contraceptive pills, gonadotropin-releasing hormone agonists, norethindrone acetate with or without aromatase inhibitors, and danazol reduce ovarian endometrioma size.

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Condition tags

endometriosisendometrioma

MeSH descriptors

Cysts Cysts Cysts Cysts Cysts Cysts Cysts Cysts Cysts Cysts Cysts Cysts Cysts Cysts Cysts Cysts Cysts Cysts Cysts Cysts

Citation neighborhood (2-hop)

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

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