Post-operative oral contraceptive use reduces the risk of ovarian endometrioma recurrence after laparoscopic excision

Takamura, Masashi; Koga, Kaori; Osuga, Yutaka; Takemura, Yuri; Hamasaki, Koji; Hirota, Yasushi; Yokosuka, Osamu; Taketani, Yuji

doi:10.1093/humrep/dep297

Cited by 87 publications

(95 citation statements)

References 22 publications

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“…Um estudo de coorte retrospectivo envolvendo 87 pacientes com endometrioma reportou menor taxa de recidiva entre as que usaram contracepção oral contínua no pós-operatório, com taxas ainda menores naquelas que mantiveram seu uso por mais de 24 meses, quando comparadas àquelas que interromperam seu uso no fim do seguimento ou àquelas que nunca usaram. As taxas de recidiva relatadas foram 2,9; 14,3 e 43,5%, respectivamente, nos grupos de uso de contracepção oral sem interrupção, uso com interrupção e grupo das que nunca usaram 18 . Achado similar foi publicado em estudo coorte no qual se observou que 94% das pacientes em uso de anticoncepção oral contínua, com seguimento por 36 meses, não tiveram recorrência, comparadas com uma taxa de 51% naquelas que não receberam esse tratamento 9 .…”

Section: Discussionunclassified

Fatores preditores de recorrência do endometrioma ovariano após tratamento laparoscópico

Carvalho

Pereira

Martins

et al. 2015

Rev. Bras. Ginecol. Obstet.

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ResumoOBJETIVO: Analisar os fatores que possam influenciar na recorrência do endometrioma ovariano após tratamento videolaparoscópico. MÉTODOS: Estudo de coorte retrospectivo. Foram avaliadas 129 pacientes submetidas à videolaparoscopia, entre 2003 e 2012, para tratamento de endometrioma ovariano, com seguimento pós-operatório mínimo de 2 anos. Foi realizada ultrassonografia transvaginal para excluir persistência da lesão e identificação de recidiva. Para comparação de variáveis contínuas foi utilizado o teste t de Student, e para o teste de homogeneidade entre as proporções, o teste do χ 2 ou exato de Fisher (para frequências menores do que cinco). Para a obtenção de fatores prognósticos ligados à recidiva foi aplicado o modelo de regressão linear multivariado. O nível de significância utilizado para a análise foi de 5%. RESULTADOS: A taxa de recorrência foi de 18.6%. O tamanho do endometrioma, a modalidade cirúrgica empregada e os dados demográficos como idade, índice de massa corpórea, presença de sintomas, tabagismo e prática de exercícios físicos não se associaram ao aumento da recorrência. Foi observado que a interrupção do tratamento clínico pós-operatório apresentou risco significativo para aumento da recorrência (OR 23,7; IC95% 5,05; p=0,001). CONCLUSÃO: O uso contínuo de contracepção oral parece reduzir dramaticamente a taxa de recidiva de endometrioma ovariano. Neste estudo, a interrupção do tratamento foi o fator associado com maior taxa de recidiva da lesão após o tratamento videolaparoscópico. Abstract PURPOSE:To analyze the factors that might influence the recurrence of ovarian endometriomas after laparoscopic excision. METHODS: A retrospective cohort study. We evaluated 129 patients who underwent laparoscopic excision of ovarian endometriomas from 2003 to 2012 and who were followed up for at least two years after surgery. Vaginal ultrasound was repeated to exclude persistent lesion and to identify recurrence. The Student's t-test was used to compare continuous variables and the χ 2 or Fischer exact test (for values of less than five) was used to test homogeneity between proportions. A logistic regression model for multivariate proportional hazards was used to analyze predictors of long-term outcome. The level of significance was set at 5% in all analyses. RESULTS: The overall rate of ovarian endometrioma recurrence was 18.6%. Endometrioma diameter, surgical procedure techniques and demographic data such as age, presenting symptoms, body mass index, smoking and physical exercise habits were not associated with recurrence, whereas interruption of postoperative medical treatment was significantly correlated with a higher recurrence rate (OR 23.7; p=0.001). CONCLUSION: Current oral contraceptive use appears to be associated with a dramatic reduction in the risk of recurrence of ovarian endometriotic cysts. Treatment interruption was associated with a higher recurrence rate of ovarian endometrioma after laparoscopic treatment.

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Section: Discussionunclassified

Fatores preditores de recorrência do endometrioma ovariano após tratamento laparoscópico

Carvalho

Pereira

Martins

et al. 2015

Rev. Bras. Ginecol. Obstet.

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“…Recurrence is very common after surgery, varying from 29 to 56 % [2,10,29], while evidence to support the efficacy and safety of many medications used to treat it is lacking [26].…”

Section: Discussionmentioning

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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“…Therefore, the authors of this study recommended regular postoperative use of COCs for the prevention of endometrioma recurrence [11]. In another study, postoperative use of COCs after laparoscopic endometrioma excision the recurrence rate was also significantly reduced (p 5 0.001) [12]. In contrast, others found no significant effect of a monophasic COC with 0.03 mg EE/0.75 mg gestoden [13].…”

Section: Estrogen/progestogen Combinations and Endometriomamentioning

confidence: 75%

Hormonal contraceptives and endometriosis/adenomyosis

Schindler¹

2010

Gynecological Endocrinology

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Over the past 50 years hormonal contraceptives have gradually developed to be cost-effective medical treatment modalities for primary and secondary therapy of endometriosis/adenomyosis. This is particularly true for the various estrogen/ progestogen combinations as monophasic -particularly progestogen-dominant -preparations in cyclic, long-cyclic and continuous treatment forms. An alternative is the progestogen-only therapy used continuously. Therapeutic effects have been shown for peritoneal, ovarian and deep-infiltrating endometriosis as well as for adenomyosis. An individualized, medical long-term treatment concept to control endometriosis/adenomyosis-related symptoms, endometriosis/adenomyosis development and minimizing the recurrence rate needs to be further studied in women, who do not desire to become pregnant.

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Post-operative oral contraceptive use reduces the risk of ovarian endometrioma recurrence after laparoscopic excision

Abstract: Post-operative OC use reduces the risk of ovarian endometrioma recurrence after laparoscopic excision. This information will help in appropriate planning of pre- and post-operative management.

Cited by 87 publications

References 22 publications

Fatores preditores de recorrência do endometrioma ovariano após tratamento laparoscópico

Fatores preditores de recorrência do endometrioma ovariano após tratamento laparoscópico

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

Hormonal contraceptives and endometriosis/adenomyosis

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