Long-Term Medical Therapy after Laparoscopic Excision of Ovarian Endometriomas: Can We Reduce and Predict the Risk of Recurrence?

Simona Del Forno, Maria Cofano, M. Cofano, Eugenia Degli Esposti, Federica Manzara, Jacopo Lenzi, Diego Raimondo, Alessandro Arena, Roberto Paradisi, Paolo Casadio, Renato Seracchioli
Gynecologic and obstetric investigation · 2021 · vol. 86(1-2) , pp. 170–176 · doi:10.1159/000514310 · PMID:33849018 · W3156188763
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Continuous estroprogestin therapy after laparoscopic endometrioma excision reduced disease recurrence compared to no medical therapy.

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Abstract

Objectives: Up to 32% of women experience anatomic recurrence after conservative surgery for endometriomas, while pain recurs in 10–40% of cases. Long-term postoperative hormonal therapy is recommended to prevent disease recurrence. We evaluated the efficacy of long-term therapy with estroprogestins (EPs) or progestins (Ps) in preventing endometrioma recurrence, as identifiable cysts and subjective symptoms, after laparoscopic excision. Design: This retrospective cohort study included 375 women submitted to laparoscopic endometrioma excision. Women were followed up at 6 and 12 months and then yearly after surgery. Based on postoperative medical therapy, women were divided into 4 groups: nonusers, cyclic EP users, continuous EP users, and progestogen users. Materials, Setting, Methods: Anamnestic and anthropometric characteristics were collected as well as clinical and surgical data. Gynecological examination, and transvaginal and transabdominal ultrasound scans were performed. Pain (numerical rating score >5) and endometrioma recurrence at ultrasound (ovarian cyst with typical sonographic features ≥10 mm in mean diameter) were recorded at each examination. The reoperation rate in women with recurrence was investigated. Results: The median follow-up was 3.7 years with a maximum of 16.7 years. Most patients used EPs (119 cyclic and 61 continuous users), 95 used P, and 100 were nonusers. In 135 women (36%), endometriotic cyst recurrence was diagnosed, with a mean diameter of 18.7 ± 10.8 mm (range 10–55 mm). The median recurrent cyst-free time was 7.9 years (95% CI 5.8–10.8). Dysmenorrhea was the first symptom to reappear, affecting 162 patients (43.2%). Upon multivariable regression analysis, continuous users had a lower risk of relapse (OR 0.56, 95% CI 0.32–0.99), in terms of both cysts and symptom recurrence, than patients who received no medications. The reoperation rate was 16.2%. Limitations: The main limitation of this study is its retrospective design. Also, women switching therapies throughout the follow-up period were sorted into one of the study groups based on the longest treatment taken, without considering the discontinuation rates. Conclusions: Long-term EPs, administered in a continuous regimen and starting immediately after conservative surgery for endometriomas, seem to reduce the disease recurrence risk.

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Condition tags

dysmenorrheaendometriosisendometrioma

MeSH descriptors

Endometriosis Ethinyl Estradiol Norpregnenes Ovarian Diseases Progestins Adult Cohort Studies Drug Combinations Dysmenorrhea Endometriosis Endometriosis Endometriosis Ethinyl Estradiol Female Humans Laparoscopy Norpregnenes Ovarian Cysts Ovarian Cysts Ovarian Cysts

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