Postoperative Medical Therapy After Surgical Treatment of Endometriosis: From Adjuvant Therapy to Tertiary Prevention

Edgardo Somigliana, Paolo Vercellini, Paola Vigano, Paola Viganò, Laura Benaglia, Andrea Busnelli, Luigi Fedele
Journal of Minimally Invasive Gynecology · 2013 · vol. 21(3) , pp. 328–334 · doi:10.1016/j.jmig.2013.10.007 · PMID:24157566 · W2073344470
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This review discusses the use of medical therapies after surgical endometriosis treatment, focusing on their role in preventing recurrence and managing the disease long-term.

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Abstract

The high rate of disease recurrence after surgery is critical and frustrating for women with endometriosis. Adjuvant treatments using a 3- to 6-months course of hormone therapy after surgery have been extensively investigated during the last 2 decades; however, results have been unsatisfactory, primarily because the benefits of hormone therapy rapidly vanish once treatment is discontinued. The protective effect is limited to the period of use. Accordingly, it is recognized that suppressive hormone therapy after surgery markedly prevents recurrent episodes only if given over the long term. The emerging view is that estroprogestins do not ameliorate the effects of surgery but demonstrate tertiary prevention of the disease. They prevent ovulation and reduce retrograde menstrual flow, two crucial events in the pathogenesis of endometriosis. The available literature strongly supports the benefits of prolonged administration of estroprogestins after surgery in preventing recurrence of endometriomas and dysmenorrhea. In contrast, data on dyspareunia and nonmenstrual pelvic pain remain scanty and unconvincing, and there is no information about recurrence of other forms of endometriosis such as peritoneal implants and adhesions. Overall, estroprogestin therapy after surgery to treat endometriosis should be recommended in women who do not seek to become pregnant. Further evidence is warranted to better delineate the beneficial effects of this emerging but convincing strategy.

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Condition tags

dysmenorrheadyspareuniaendometriosischronic_pelvic_pain

MeSH descriptors

Endometriosis Ethinyl Estradiol Norpregnenes Chemotherapy, Adjuvant Combined Modality Therapy Drug Combinations Dysmenorrhea Dysmenorrhea Dysmenorrhea Dyspareunia Endometriosis Endometriosis Endometriosis Ethinyl Estradiol Female Humans Norpregnenes Pelvic Pain Pelvic Pain Postoperative Period

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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Cited by (50)

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