Comparison of Outcomes of Different Postoperative Hormone Therapy in the Treatment of Ovarian Endometriosis: A Brief Report

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This study compared progestin and GnRH therapy after ovarian endometriosis surgery, finding both improved outcomes but progestin showed greater benefits, though recurrence rates increased for all treatments.

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This brief report compared postoperative hormone therapy regimens in 399 patients with ovarian endometriosis after surgery, assigning participants to four groups: no postoperative hormone therapy, norethindrone progestin at 1.2 mg/day or 5 mg/day, or a GnRH regimen of 2.0 mg every 2 weeks. Outcomes included menstrual bleeding profiles, cumulative recurrence rate, complication incidence, and endometrioma diameter at recurrence. Compared with no hormone therapy, both progestin doses and GnRH improved menstrual bleeding profiles and reduced recurrence and recurrence-associated endometrioma diameter, with no significant differences in complication incidence among groups; however, after treatment completion, recurrence rate and endometrioma diameter increased in all hormonally treated groups, and the paper notes progestin may be a better choice based on these comparisons. This paper is centrally about endometriosis — specifically, it compares postoperative progestin versus GnRH hormone therapy outcomes in ovarian endometriosis after surgery.

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Abstract

IntroductionHormone therapy is widely used in the treatment of patients with ovarian endometriosis after surgery, and progestin and gonadotropin-releasing hormone (GnRH) are two of the most widely used hormones. This study aimed to compare the outcomes of progestin and GnRH in the treatment of ovarian endometriosis after surgery.MethodsA total of 399 patients with ovarian endometriosis were included and divided into four groups to receive different treatments. Group A received no postoperative hormone therapy; patients in group B1 and B2 were treated with different doses of norethindrone (progestin, 1.2 and 5 mg/day, respectively); patients in group C were treated with GnRH (2.0 mg every 2 weeks). Treatment outcomes including menstrual bleeding profiles, cumulative recurrence rate, incidence of complications, and endometrioma diameter in the case of recurrence were recorded and compared between groups.ResultsCompared with group A, group B1, B2 and C showed significantly improved menstrual bleeding profiles and reduced cumulative recurrence rate and endometrioma diameter after recurrence. In addition, compared with group C, menstrual bleeding profiles were significantly improved and cumulative recurrence rate and endometrioma diameter were significantly reduced in group B1 and B2. No significant differences in incidence of complications during treatment were found among groups. After treatment, recurrence rate and endometrioma diameter were significantly increased in group B1, B2, and C.ConclusionBoth progestin and GnRH can significantly improve the conditions of patients with ovarian endometriosis after surgery, but progestin may be a better choice. Both therapies are challenged by the increased recurrence rate and endometrioma diameter after treatment.
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Abstract

Introduction Hormone therapy is widely used in the treatment of patients with ovarian endometriosis after surgery, and progestin and gonadotropin-releasing hormone (GnRH) are two of the most widely used hormones. This study aimed to compare the outcomes of progestin and GnRH in the treatment of ovarian endometriosis after surgery.

Methods

A total of 399 patients with ovarian endometriosis were included and divided into four groups to receive different treatments. Group A received no postoperative hormone therapy; patients in group B1 and B2 were treated with different doses of norethindrone (progestin, 1.2 and 5 mg/day, respectively); patients in group C were treated with GnRH (2.0 mg every 2 weeks). Treatment outcomes including menstrual bleeding profiles, cumulative recurrence rate, incidence of complications, and endometrioma diameter in the case of recurrence were recorded and compared between groups.

Results

Compared with group A, group B1, B2 and C showed significantly improved menstrual bleeding profiles and reduced cumulative recurrence rate and endometrioma diameter after recurrence. In addition, compared with group C, menstrual bleeding profiles were significantly improved and cumulative recurrence rate and endometrioma diameter were significantly reduced in group B1 and B2. No significant differences in incidence of complications during treatment were found among groups. After treatment, recurrence rate and endometrioma diameter were significantly increased in group B1, B2, and C.

Conclusion

Both progestin and GnRH can significantly improve the conditions of patients with ovarian endometriosis after surgery, but progestin may be a better choice. Both therapies are challenged by the increased recurrence rate and endometrioma diameter after treatment.

References

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Acknowledgements

We thank the participants of the study. Funding No funding or sponsorship was received for this study or publication of this article. The article processing charges were funded by the authors. Authorship All authors including Songnan Zhu, Yingjun Zhu, Yabo Liu, and Hong Zhang meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. Disclosures Songnan Zhu, Yingjun Zhu, Yabo Liu, and Hong Zhang have nothing to disclose. Compliance with Ethics Guidelines This study was approved by the ethics committee of Tianjin Central Obstetrics and Gynecology Hospital. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. Data Availability The data sets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. Author information Authors and Affiliations Corresponding author Additional information Enhanced digital features To view enhanced digital features for this article go to https://doi.org/10.6084/m9.figshare.6210047. Rights and permissions About this article Cite this article Zhu, S., Zhu, Y., Liu, Y. et al. Comparison of Outcomes of Different Postoperative Hormone Therapy in the Treatment of Ovarian Endometriosis: A Brief Report. Adv Ther 35, 857–863 (2018). https://doi.org/10.1007/s12325-018-0715-z Received: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s12325-018-0715-z

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endometriosis

MeSH descriptors

Endometriosis Endometriosis Gonadotropin-Releasing Hormone Menorrhagia Norethindrone Progestins Adult Endometriosis Female Gonadotropin-Releasing Hormone Humans Laparoscopy Menorrhagia Norethindrone Postoperative Period Progestins Treatment Outcome

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