Postoperative Hormonal Regimens and Two-Year Ovarian Endometrioma Recurrence Following Laparoscopic Cystectomy: A Weighted Retrospective Cohort Study

Lu W, Wenjing Lu, Huazhang Miao, Miao H, Liu M, Minyan Liu, Shi J, Junzhu Shi, Liu J, Jiao Liu, Li L, Li Li
Journal of Minimally Invasive Gynecology · 2026 · doi:10.1016/j.jmig.2026.09.016 · PMID:43025488 · W7226029628
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Abstract

STUDY OBJECTIVE: To compare 24-month imaging-defined ovarian endometrioma recurrence hazards across four postoperative hormonal regimens after laparoscopic cystectomy. DESIGN: Single-center weighted retrospective cohort study. SETTING: Guangdong Women and Children Hospital. PATIENTS: Women aged 18-45 years who underwent laparoscopic cystectomy for ovarian endometrioma from August 2015 to August 2023 with documented 6-month prescription coverage for one regimen. INTERVENTIONS: Combined oral contraceptives (COC), gonadotropin-releasing hormone agonists (GnRH-a), dienogest, or dydrogesterone initiated within 1 month without switching or sequential therapy. MEASUREMENTS AND MAIN RESULTS: Imaging-defined recurrence was a new endometrioma-compatible cyst >2 cm on at least two follow-up ultrasound examinations or confirmed by repeat surgery or pathology. Among 1121 women, 160 (14.3%) experienced recurrence within 24 months. Compared with COC, GnRH-a (adjusted hazard ratio [HR], 0.405; 95% confidence interval [CI], 0.253-0.649) and dienogest (adjusted HR, 0.417; 95% CI, 0.251-0.690) were associated with lower recurrence hazards. The dydrogesterone estimate had a wider 95% CI (adjusted HR, 0.504; 95% CI, 0.265-0.958). Higher baseline cancer antigen 125 (CA-125; adjusted HR per 1 U/mL, 1.002; 95% CI, 1.001-1.004) and deep infiltrating endometriosis (DIE; adjusted HR, 2.358; 95% CI, 1.593-3.490) were associated with greater recurrence hazards. CONCLUSION: Among women with documented 6-month prescription coverage, GnRH-a and dienogest were associated with lower 24-month hazards of imaging-defined ovarian endometrioma recurrence than COC. The dydrogesterone estimate was below 1 but less consistent across sensitivity analyses. These associations should not be extrapolated to overall endometriosis control or long-term pain outcomes.

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