Impact of GnRH agonist treatment on recurrence of ovarian endometriomas after conservative laparoscopic surgery

Jee, Byung Chul; Lee, Joong Yeup; Suh, Chang Suk; Kim, Seok Hyun; Choi, Young Min; Moon, Shin Yong

doi:10.1016/j.fertnstert.2007.11.027

Cited by 68 publications

(57 citation statements)

References 39 publications

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“…''Unfortunately, there is no permanent cure for this condition, so it often requires a life-long management plan with the goal of maximizing the use of medical treatment and avoiding repeated surgical procedures'', reports the American Society of Reproductive Medicine [3]. Lesions and symptoms very frequently return after medication is discontinued or after conservative surgery is performed, a fact which frustrates both patients and clinicians [4] and is estimated to occur in 30-50 % of cases within 2-5 years [2,[5][6][7][8][9][10]. The American College of Obstetricians and Gynecologists Practice Bulletin suggests that the true recurrence rate must be even higher than the rate generally reported in literature, because most publications report symptomatic disease only [11].…”

Section: Introductionmentioning

confidence: 99%

Oral contraceptives in the prevention of endometrioma recurrence: does the different progestins used make a difference?

Cucinella

Granese²,

Calagna

et al. 2013

Arch Gynecol Obstet

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Objective The primary aim of the study was to analyze the endometrioma recurrence rate in patients who underwent laparoscopic excision followed by postoperative longterm regimen of oral contraceptives (OCs). Materials and methods 168 patients who underwent a conservative laparoscopic surgery for endometrioma, during the period between September 2009 and August 2010 in three university hospitals were studied. A long-term OCs therapy was offered to all women following surgery. Patients were randomly divided into three groups according to different progestins used (desogestrel, gestodene, dienogest). Women who refused a postoperative hormonal therapy served as control. Follow-up visits and transvaginal scan were planned at 1, 3, 6, 12, and 24 months after surgery. All patients who showed an ultrasound persistence of the endometrioma at 1 month follow-up were excluded from clinical analysis.Results Of the 168 patients, 131 completed the 24 months follow-up. Endometrioma recurrence was found in 21 (12.5 %) of all patients, it was unilateral in 17 cases while bilateral in 4 cases. The rate of recurrent endometrioma was statistically significant in non-users compared to the long-term OCs treated patients. Conclusion The current data suggest the usefulness of long-term OCs regimen after conservative surgery for the prevention of ovarian endometrioma recurrence. As a statistical significant difference could not be observed between OCs groups, further study on the individual molecules is required in order to really understand the effect of each of them.

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Section: Introductionmentioning

confidence: 99%

Oral contraceptives in the prevention of endometrioma recurrence: does the different progestins used make a difference?

Cucinella

Granese²,

Calagna

et al. 2013

Arch Gynecol Obstet

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“…The remaining ovarian tissue was sutured to enhance its aggregation [38]. The 3-month GnRH agonist treatment was inadequate for stage III and IV endometriosis [39], and the beneficial effect of a 6-month course of GnRH agonist treatment after laparoscopy [40] was demonstrated. This was evident from the results showing that the subsequent time-managed medical phase of our advanced protocol, which includes various periods of GnRH analog injection after the laparoscopy (depending on endometriosis stage), adequately compensated for the laparoscopic shortcomings based on the high cure rate of the patients.…”

Section: Discussionmentioning

confidence: 99%

“…While medications could be effective following the removal of endometrial lesions [15] [16], no explanation exists for the ineffectiveness of medication treatment before endometriosis cysts or spots are removed [16] [17] [18] [19]. The need for drug treatment after laparoscopy has also been indicated by previous studies [20] [21] [22], and the use of 6-month gonadotropin-releasing hormone (GnRH) agonist therapy following laparoscopy prevented endometriosis recurrence [23]. Presently, new endometriosis treatment strategies are required and should be developed.…”

Section: Introductionmentioning

confidence: 99%

Efficacy Analysis of an Experience on Development of the Combination Therapy Protocol for Endometriosis Management

Saremi¹,

Eshkevari²,

Pour³

et al. 2017

OJOG

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Purpose: Endometriosis can be managed effectively by medication, surgery, or a combination of both. Numerous studies have been conducted on surgical and medication treatment options, but their results are still under discussion. Therefore, we performed a study to develop a combinational treatment for various stages of endometriosis. Methods: Over a 3-year period, 218 documented endometriosis patients were classified in 4 stages. After first laparoscopy (with electrocoagulation and adhesion removal for stages I to III), the patients were treated with GnRH analogs (Gonadotropin Releasing Hormone Agonist-375 mg of Decapeptyl) for 3, 6 & 6 months, respectively. The second and third laparoscopy procedures were performed after 3 and 6 months, with add-back therapy. The treatment was evaluated by direct observation based on laparoscopic view and the pain relief was measured by the VAS (Visual Analogue Scale) after the first step of medication for patients of stages I-III. Results: After 3 months, 70/76 patients (91.9%) with stage-I endometriosis showed complete recovery (six cases after 6 months) while 65/72 and 32/43 cases with stage-II and -III (90.3 and 74.4%), respectively, showed complete recovery after 6 months of treatment. The remaining patients had GnRH treatment for another 3 months, and all showed a complete recovery after 9 months. Furthermore, 12 of the patients with stage-IV symptoms were candidates for laparoscopy or laparotomy, and their treatment response rate was 55.6%. The pain relief was significant after the combinational treatment in patients with stages I-III (P = 0.0001). Conclusion: Our study showed efficacy of the developed protocol for the endometriosis management.

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“…À 18 mois, aucune différence significative n'était retrouvée en termes de récidive ; seul le taux de dysménorrhée était significativement moins important dans le groupe GnRH. En fait, la majorité des études rapportant un traitement sur une période relativement courte (6 mois ou moins) ne retrouve pas ou peu de différence dans l'effet de ce traitement postopératoire court quel qu'il soit, l'effet bénéfique de l'aménorrhée sur la récidive des douleurs semble néanmoins établi quel que soit le traitement [121][122][123][124][125][126][127][128][129][130][131][132][133][134]. Si ce traitement n'est pas interrompu, les résultats semblent meilleurs en termes de récidive des endométriomes mais ils ne peuvent faire appel qu'à un traitement contraceptif oral progestatif (COP) ou progestatif dont on connaît bien les effets à long terme [110,120,135].…”

Section: Traitement Postopératoireunclassified

Chirurgie des endométriomes ovariens : de la physiopathologie à la prise en charge pratique pré-, per- et postopératoire

Bourdel

Roman

Mage

et al. 2011

Gynécologie Obstétrique & Fertilité

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Impact of GnRH agonist treatment on recurrence of ovarian endometriomas after conservative laparoscopic surgery

Cited by 68 publications

References 39 publications

Oral contraceptives in the prevention of endometrioma recurrence: does the different progestins used make a difference?

Oral contraceptives in the prevention of endometrioma recurrence: does the different progestins used make a difference?

Efficacy Analysis of an Experience on Development of the Combination Therapy Protocol for Endometriosis Management

Chirurgie des endométriomes ovariens : de la physiopathologie à la prise en charge pratique pré-, per- et postopératoire

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