The use of GnRH agonists in deep endometriosis after conservative surgery - case report

Severe endometriosis requires complex surgical and me­­di­­cal treatment to suppress the symptoms that may af­­­fect the quality of life of patients with this pathology. We report a case of stage IV endometriosis treated with gonadotropin-releasing hormone (GnRH) agonist after con­ser­va­tive surgery. An 18-year-old nulliparous wo­man was admitted in our clinic with a history of se­vere chronic pel­vic pain, dysmenorrhea, dyspareunia and dysuria. After a clinical, biological, transvaginal ul­tra­so­no­graphy and pelvic CT examination, we diagnosed an rectovaginal en­do­me­trio­sis and bilateral ovarian endometriotic cyst. Du­ring laparotomy, a stage IV pelvic endometriosis was found, with bilateral endometrioma of the ovaries, multiple adhesions, deep and superficial lesions of endometriosis. An extensive adhesiolysis, left oophorectomy, right cystectomy and partial omen­tec­tomy were performed. For the next 1.5 years, the pa­tient was treated with GnRH for 3 months (goserelin acetate 3.6 mg/month) and then with continuous oral pro­ges­tin therapy. After 1.5 years, the patient remained asym­p­to­matic, the treatment improving the quality of life. In selected cases, GnRH agonists remains an effective treat­ment for recurrent symptoms of endometriosis, es­pe­cially if administered early after surgical therapy.