Analyzing the Risk Factors for Recurrence of Endometrioma and Dysmenorrhea in Patients with Endometriosis

Jichan Nie,&ast; Han Yan,&ast; Wei Jiang Department of Gynecology, Obstetrics & Gynecology Hospital of Fudan University, Shanghai Key Laboratory of Reproduction and Development, Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200433, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Wei Jiang, Department of Gynecology, Obstetrics & Gynecology Hospital of Fudan University, Shanghai Key Laboratory of Reproduction and Development, Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200433, People’s Republic of China, Email [email protected]: Recurrence of endometrioma and dysmenorrhea after surgery remains a major clinical challenge. Identifying reliable risk factors is essential to optimize individualized treatment and follow-up strategies. However, large-scale data from Chinese populations are limited.Materials and Methods: We retrospectively analyzed 1,598 reproductive-aged women with pathologically confirmed endometriosis who underwent surgery between 2009 and 2010 and were followed for up to 7 years. Clinical, surgical, and follow-up data were collected. Kaplan–Meier survival analysis and Cox proportional hazards models were used to assess recurrence and identify independent predictors.Results: During follow-up, 348 patients (21.8%) developed endometrioma recurrence, and 187 of 846 with baseline dysmenorrhea (22.1%) experienced recurrence. The cumulative recurrence rates were 12%, 38%, 55%, and 65% for endometrioma at 1, 3, 5, and 7 years, and 28%, 52%, 68%, and 75% for dysmenorrhea at 1, 3, 5, and 7 years. Multivariable Cox regression identified bilateral ovarian cysts (HR 1.36, 95% CI 1.06– 1.74, P = 0.015), older age at surgery (HR 1.04, 95% CI 1.00– 1.08, P = 0.029), lack of postoperative medical therapy (HR 2.10, 95% CI 1.28– 3.46, P = 0.003), and higher postoperative VAS scores (HR 1.10, 95% CI 1.05– 1.15, P < 0.001) as independent risk factors for endometrioma recurrence. For dysmenorrhea recurrence, significant predictors were a history of endometriosis (HR 2.06, 95% CI 1.19– 3.57, P = 0.010), higher preoperative VAS scores (HR 1.14, 95% CI 1.02– 1.28, P = 0.026), and higher postoperative VAS scores (HR 1.27, 95% CI 1.18– 1.39, P < 0.001).Conclusion: Recurrence of endometrioma and dysmenorrhea is common after surgery. Bilateral cysts, older age, lack of postoperative therapy, and higher postoperative pain scores independently increase the risk of endometrioma recurrence, while both preoperative and postoperative pain severity, as well as a history of endometriosis, are strong predictors of dysmenorrhea recurrence.Keywords: endometriosis, dysmenorrhea, recurrence, risk factors, cox regression