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

Abstract

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.

Interstitial Pregnancy: A ‘Road Map' of Surgical Treatment Based on a Systematic Review of the Literature

“…Nowadays, laparoscopy may be considered the ‘gold standard' in the treatment of certain general and gynecologic diseases [61,62] and enjoys a clinical success rate of almost 80% when C and R are grouped together. Conservative laparoscopic treatment is now the preferred surgical approach in cases of EP that are not eligible for medical treatment.…”

Gonadotrophin‐releasing hormone analogue or dienogest plus estradiol valerate to prevent pain recurrence after laparoscopic surgery for endometriosis: a multi‐center randomized trial

“…The progestogen component of the “combined pill” is widely considered the active therapeutic drug in treating or preventing endometriosis . In recent years, the attention of clinicians has been focused on dienogest, which is currently the only steroidal treatment marketed in most of Europe.…”

“…A comparative study between postoperative administration of OCs containing dienogest or a levonorgestrel intrauterine system (LNG-IUS) for prevention of pain relapse and disease recurrence in endometriosis patients, demonstrated better efficacy of OCs in reducing pelvic pain at 12 months of follow up (2). The progestogen component of the "combined pill" is widely considered the active therapeutic drug in treating or preventing endometriosis (12). In recent years, the attention of clinicians has been focused on dienogest, which is currently the only steroidal treatment marketed in most of Europe.…”

Controversies in the Management of Endometrioma

“…Women declining OCP therapy served as a nonrandomized control group, and these women had a higher rate of recurrence of endometrioma. 33 One additional RCT also assessed continuous versus cyclic OCPs postoperatively in women with endometrioma. Muzii et al 34 compared continuous to cyclic OCP use after laparoscopic cystectomy for endometrioma in 57 women.…”