An Evaluation of the Conservative Treatment of Endometriosis

A. Grant, Alan Grant, Grant A
The Australian & New Zealand journal of obstetrics & gynaecology · 1963 · vol. 3(4) , pp. 162–167 · doi:10.1111/j.1479-828x.1963.tb00238.x · PMID:14102743 · W2100547987
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This study compared cyclic and continuous progestogen treatments for endometriosis, finding continuous treatment yielded better symptom relief and pregnancy rates, and that conservative surgery resulted in an 80% cure rate for infertility.

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Abstract

Summary: An evaluation has been made of the treatment of endometriosis by conservative surgery and by progestogens. In our series of patients, progestogens were given by the intermittent, discontinuous or cyclic method for 20 days every month for 6 months. The results of treatment with such a regime have been compared with those obtained by other workers, both in Australia and abroad, using the continuous regime (pseudo‐pregnancy). The pseudo‐pregnancy technique gave a 15% better result than the cyclic one when the patients were re‐assessed 6 months after cessation of treatment. The pseudo‐pregnancy regime produced a slightly better incidence of subsequent pregnancy in the hands of most clinicians. The cyclic treatment is cheaper, available to a larger group of patients, and less psychologically disturbing, since some sort of period usually ensues each month. When oestrogens were added to the progestogens there was more nausea but less amenorrhoea. Reasons are given why conservative surgery is preferred to progestogens in the initial treatment plan. Before conservative surgery is performed, the administration of progestogens for a month softens the endometriotic adhesions so that less oozing occurs and the tissue planes become easier to dissect. Thirty‐eight per cent, of patients who desired to conceive were successful after conservative surgery. A radical procedure (operation or X‐ray castration) was necessary after conservative surgery in 5% (lowest) and 15% (highest) of those treated. Another 5% required hormonal treatment after operation. The apparent cure rate after conservative surgery was therefore not less than 80%. Endometriosis is present in private patients suffering from infertility and pelvic pathology in one‐third to one‐half of the cases.

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Condition tags

endometriosisinfertility

MeSH descriptors

Amenorrhea Endometriosis Ethinyl Estradiol Nausea Neoplasms Norethindrone Pregnancy Complications Statistics as Topic Surgical Procedures, Operative Toxicology Uterine Hemorrhage Female Humans Neoplasms Pregnancy

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