Treatment of ovarian endometrial cysts in thecontext of recurrence and fertility

Abstract

An approach to ovarian endometrial cysts has changed considerably during recent years, especially in regard to treatment of recurrent endometriosis, fertility sparing and infertility management. Surgical treatment is the primary therapeutic option. The most efficient types of treatment are radical procedures involving adhesiolysis, removal of the cyst along with its capsule and any remaining endometriotic foci. However, small asymptomatic cysts should not be treated surgically, especially in patients older than 35 years. Surgical treatment can be considered in infertile women and those who failed to get pregnant despite 1-1.5 years of trials, as well as in cases in which in vitro fertilization is not an option. Also large cysts, with more than 4 cm in diameter, should be treated surgically due to the risk of their rupture or torsion. The most efficient preventive measure for recurrent ovarian endometriosis is unilateral oophorectomy with sparing the contralateral ovary. Such a procedure should be considered in women who are no longer interested in childbearing or present with another endometriotic cyst in the same ovary. The role of pharmacotherapy is fairly limited; it should be considered in patients in whom diffuse endometriosis is associated with pain. Therapeutic agents from the following groups can be used: estrogen-progestin preparation, gestagens, including progesteronereleasing intrauterine systems and gonadotropin-releasing hormone agonists. Women with infertility should get pregnant as soon as possible, and in patients who failed to get pregnant and/or are older than 35 years, in vitro fertilization should be the treatment of choice.

Interleukin-1/-33 Signaling Pathways as Therapeutic Targets for Endometriosis

“…However, after medical or surgical treatment, there is a high recurrence frequency of endometriosis; 21.5% at 2 years and 40–50% at 5 years (29). Furthermore, either therapy is limited to patients who do not wish to become pregnant (30). The limitations of currently available options prompted us to seek novel therapies for endometriosis.…”

Untitled

“…Inverse association of age during surgery and endometrioma recurrence has been consistently mentioned in previous studies [1]. Some authors believe that higher serum levels of estrogen in younger patients may induce aggressive forms of endometriosis; others suggest that they have relatively longer reproductive period [1,17,21]. Oppositely, studies with teenagers show that recurrence rate after surgery in this population is lower than compared with adults [21,22].…”

Methods to Improve the Treatment Outcomes for Infertility Associated with Endometriomas

“…После повторных операций беременность наступила у 5 (35,7%) из 14 участниц группы 1, тогда как в группе женщин, которых вели в соответствии с разработанным нами подходом, таких случаев было только 3 (10%) (p = 0,031). [2,7,10]. В настоящее время многие исследователи полагают, что к вопросу о хирургическом лечении ЭКЯ малого размера следует подходить очень внимательно.…”

“…Однако возникают два вопроса: какова максимальная продолжительность выжидательной тактики и следует ли ее применять у всех пациенток с эндомет риозом? Несомненно, выжидательную тактику нужно исключить у женщин с тазовой болью; в таких случаях хирургичес кое вмешательство является методом выбора [9,10]. Однако тактика лечения при отсутствии клиничес ких проявлений до настоящего времени активно дискутируется.…”

“…Все эти данные свидетельствуют в пользу хирургического лечения ЭКЯ, особенно у молодых женщин с бесплодием [14][15][16]. Однако известно, что хирургическое лечение тоже снижает овариальный резерв яичников, способствуя тем самым репродуктивному старению и ускоряя наступление менопаузы, особенно в случае повторных операций [10,15].…”