Endometrioid ovarian cysts: a rationale for post-operative hormonal therapy

This paper discusses the rationale for post-operative hormonal therapy for endometrioid ovarian cysts by focusing on how endogenous and exogenous estradiol (EE) influences endometriosis tissue growth and how progestogens exert antiproliferative effects. It argues that endometrioid tissue can produce estradiol from inactive precursors and that EE may enhance the inhibitory effect of progestogens by inducing progesterone receptor (PR) expression, with simultaneous EE and progestogen promoting rapid maximal PR induction. The authors use this mechanistic framing to support the concept that combined hormonal contraceptives with strong antiproliferative progestogenic activity, specifically dienogest, could be preferred after surgery. The paper’s limitation is that it is largely a theoretical/biological rationale rather than a report of original empirical clinical outcomes. This paper is centrally about endometriosis—specifically endometrioid ovarian cysts and a mechanistic rationale for post-operative hormonal therapy involving dienogest-containing combined regimens.

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