A Randomized Control Trial of Combined Surgical and Hormonal Therapy of Endometriosis

Abstract

Aim: To evaluate the three therapy strategies including surgical therapy, hormonal therapy, and combined treatment for the management of endometriosis Study design: A multicentric randomized control trial Place and Duration: This study was conducted in 6 different hospitals of Pakistan, Muhammad Medical and Dental College Ratanabad Mirpurkhas, Social Security Landhi Hospital Karachi, Sindh Government CDF Hospital , Bilawal Medical College for Boys Jamshoro, Ghulam Muhammad Mahar Medical College Sukkur, Bahria International Hospital Karachi, Sandeman Provincial Hospital Quetta Pakistan Pakistan from June 2020 to June 2021. Methodology: The study included 360 participants with genital endometriosis. The age of the patients ranged from 18 years to 45 years. All the patients did not have any previous surgical intervention. The patients were randomly treated with one of the three treatments. A laparoscopic evaluation was done after three months of hormonal and combined therapy. Re-evaluation of surgically treated patients was done after 5 to 6 months. Stage of endometriosis, recurrence of symptoms, and the rate of pregnancy were noted in the re-evaluation phase of the study. Results: The overall cure rate of all types of endometriosis was 56.11% after every regimen of treatment. The cure rate after treatment from combined therapy was 60%. Those treated exclusively by hormone therapy showed a cure rate of 54.17%. A total of 54.17% of patients were cured exclusively by surgical treatment. The rate of recurrence was lowest in the patients given combined therapy. Dyspareunia and dysmenorrhea were significantly reduced. The overall rate of pregnancy was 53% to 64%. The rate of pregnancy was not different among all the groups. Conclusion: After giving hormonal therapy, surgical treatment, and combined treatment, it has been noticed that recurrence was lowest in the combined medical and surgical treatment group. The rate of pregnancy had also got better after all the means of treatment. The highest rate of cure was achieved by combined therapy. Keywords: Endometriosis, laparoscopy, hormone therapy, combined treatment, infertility, recurrence

The treatment of endometriosis-associated infertility

“…In their randomized controlled trial (RCT), Bala et al found no difference between GnRHa, surgery or combined treatment on the CPR or LBR [14]. However, there are uncertainties in the method of randomization, patient demographics and fertility outcomes and firm conclusions cannot be drawn on the basis of this study.…”