nach oben

Erschienen in:

01.10.2013 | General Gynecology

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

verfasst von: Gaspare Cucinella, Roberta Granese, Gloria Calagna, Alessandro Svelato, Salvatore Saitta, Gabriele Tonni, Pasquale De Franciscis, Nicola Colacurci, Antonino Perino

Erschienen in: Archives of Gynecology and Obstetrics | Ausgabe 4/2013

Einloggen, um Zugang zu erhalten

Abstract

Objective

The primary aim of the study was to analyze the endometrioma recurrence rate in patients who underwent laparoscopic excision followed by postoperative long-term 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.

Eskenazi B, Warner ML (1997) Epidemiology of endometriosis. Obstet Gynecol Clin North Am 24:235–258PubMedCrossRef

Seracchioli R, Mabrouk M, Frascà C et al (2010) Long-term cyclic and continuous oral contraceptive therapy and endometrioma recurrence: a randomized controlled trial. Fertil Steril 93:52–56PubMedCrossRef

The Practice Committee of the American Society for Reproductive Medicine (2008) Treatment of pelvic pain associated with endometriosis. Fertil Steril 90(Suppl 5):S260–S269

Exacoustos C, Zupi E, Amadio A et al (2006) Recurrence of endometriomas after laparoscopic removal: sonographic and clinical follow-up and indication for second surgery. J Minim Invasive Gynecol 13:281–288PubMedCrossRef

Vercellini P, Somigliana E, Viganò P, De Matteis S, Barbara G, Fedele L (2010) Post-operative endometriosis recurrence: a plea for prevention based on pathogenetic, epidemiological and clinical evidence. Reprod Biomed Online 21:259–265PubMedCrossRef

Koga K, Takemura Y, Osuga Y et al (2006) Recurrence of ovarian endometrioma after laparoscopic excision. Hum Reprod 21:2171–2174PubMedCrossRef

Jee BC, Lee JY, Suh CS et al (2009) Impact of GnRH agonist treatment on recurrence of ovarian endometriomas after conservative laparoscopic surgery. Fertil Steril 91:40–45PubMedCrossRef

Kikuchi I, Takeuchi H, Kitade M et al (2006) Recurrence rate of endometriomas following a laparoscopic cystectomy. Acta Obstet Gynecol Scand 85:1120–1124PubMedCrossRef

Liu X, Yuan L, Shen F et al (2007) Patterns of and risk factors for recurrence in women with ovarian endometriosis. Obstet Gynecol 109:1411–1420PubMedCrossRef

10.

Vercellini P, Somigliana E, Daguati R et al (2008) Postoperative oral contraceptive exposure and risk of endometrioma recurrence. Am J Obstet Gynecol 198:504.e1–504.e5CrossRef

11.

ACOG Committee on Practice Bulletins-Gynaecology. ACOG practice bulletin. Medical management of endometriosis. Number 11, December 1999 (replaces technical bulletin number 184, September 1993) (2000) Clinical management guidelines for obstetrician-gynecologists. Int J Gynaecol Obstet 71(2):183–196CrossRef

12.

Donnez J, Nisolle M, Gillet N et al (1996) Large ovarian endometriomas. Hum Reprod 11:641–646PubMedCrossRef

13.

Sutton CJ, Ewen SP, Jacobs SA et al (1997) Laser laparoscopic surgery in the treatment of ovarian endometriomas. J Am Assoc Gynecol Laparosc 4:319–323PubMedCrossRef

14.

Yuen PM, Yu KM, Yip SK et al (1997) A randomized prospective study of laparoscopy and laparotomy in the management of benign ovarian masses. Am J Obstet Gynecol 177:109–114PubMedCrossRef

15.

Luciano AA, Lowney J, Jacobs SL (1992) Endoscopic treatment of endometriosis-associated infertility. Therapeutic, economic and social benefits. J Reprod Med 37:573–576PubMed

16.

Chapron C, Vercellini P, Barakat H et al (2002) Management of ovarian endometriomas. Hum Reprod Update 8:591–597PubMedCrossRef

17.

Fedele L, Bianchi S, Zanconato G et al (2006) Laparoscopic excision of recurrent endometriomas: long-term outcome and comparison with primary surgery. Fertil Steril 85:694–699PubMedCrossRef

18.

Nezhat F, Nezhat C, Allan CJ, Metzger DA, Sears DL (1992) Clinical and histologic classification of endometriomas. Implications for a mechanism of pathogenesis. J Reprod Med 37:771–776PubMed

19.

Jain S, Dalton ME (1999) Chocolate cyst from ovarian follicles. Fertil Steril 72:852–856PubMedCrossRef

20.

Busacca M, Riparini J, Somigliana E et al (2006) Postsurgical ovarian failure after laparoscopic excision of bilateral endometriomas. Am J Obstet Gynecol 195:421–425PubMedCrossRef

21.

Somigliana E, Vercellini P, Viganò P et al (2006) Should endometriomas be treated prior to IVF-ICSI cycles? Hum Reprod Update 12:57–64PubMedCrossRef

22.

Petraglia F, Hornung D, Seitz C, Faustmann T, Gerlinger C, Luisi S, Lazzeri L, Strowitzki T (2012) Reduced pelvic pain in women with endometriosis: efficacy of long-term dienogest treatment. Arch Gynecol Obstet 285:167–173PubMedCrossRef

23.

Seracchioli R, Mabrouk M, Manuzzi L, Vicenzi C, Frascà C, Elmakky A, Venturoli S (2009) Post-operative use of oral contraceptive pills for prevention of anatomical relapse or symptom recurrence after conservative surgery for endometriosis. Human Reprod 24:2729–2735CrossRef

24.

Vercellini P, Fedele L, Pietropaolo G et al (2003) Progestogens for endometriosis: forward to the past. Hum reprod Update 9:387–396PubMedCrossRef

25.

Foster RH, Wilde MI (1998) Dienogest. Drugs 56:825–833PubMedCrossRef

26.

Schindler AE (2011) Dienogest in long-term treatment of endometriosis. Int J Womens Health 3:175–184PubMedCrossRef

27.

The American Fertility Society (1985) Revised American fertility society classification of endometriosis. Fertil Steril 43:351–352

28.

Mais V, Guerriero S, Ajossa S, Angiolucci M, Paoletti AM, Melis GB (1993) The efficiency of transvaginal ultrasonography in the diagnosis of endometrioma. Fertil Steril 60:776–780PubMed

29.

Takamura M, Koga K, Osuga Y et al (2009) Post-operative oral contraceptive use reduces the risk of ovarian endometrioma recurrence after laparoscopic excision. Hum Reprod 24:3042–3048PubMedCrossRef

30.

Missmer SA, Cramer DW (2003) The epidemiology of endometriosis. Obstet Gynecol Clin North Am 30:1–19PubMedCrossRef

31.

Viganò P, Parazzini F, Somigliana E et al (2004) Endometriosis: epidemiology and aetiological factors. Best Pract Res Clin Obstet Gynecol 18:177–200CrossRef

32.

Rodgers AK, Falcone T (2008) Treatment strategies for endometriosis. Expert Opin Pharmacother 9:243–255PubMedCrossRef

33.

Meresman GF, Auge L, Baranao RI et al (2002) Oral contraceptives suppress cell proliferation and enhance apoptosis of eutopic endometrial tissue from patients with endometriosis. Fertil Steril 77:1141–1147PubMedCrossRef

34.

Vercellini P, Somigliana E, Vigano P et al (2008) Endometriosis: current and future medical therapies. Best Pract Res Clin Obstet Gynaecol 22:275–306PubMedCrossRef

35.

Vercellini P, Frontino G, De Giorgi O et al (2003) Continuous use of an oral contraceptive for endometriosis- associated recurrent dysmenorrhea that does not respond to a cyclic pill regimen. Fertil Steril 80:560–563PubMedCrossRef

36.

Muzii L, Marana R, Caruana P et al (2000) Postoperative administration of monophasic combined oral contraceptives after laparoscopic treatment of ovarian endometriomas: a prospective, randomized trial. Am J Obstet Gynecol 183:588–592PubMedCrossRef

37.

Vercellini P, Eskenazi B, Consonni D, Somigliana E, Parazzini F, Abbiati A, Fedele L (2011) Oral contraceptives and risk of endometriosis: a systematic review and meta-analysis. Hum Reprod Update 17:159–170PubMedCrossRef

38.

Meresman GF, Bilotas M, Abello V, Buquet R, Tesone M, Sueldo C (2005) Effects of aromatase inhibitors on proliferation and apoptosis in eutopic endometrial cell cultures from patients with endometriosis. Fertil Steril 84:459–463PubMedCrossRef

39.

Maia H Jr, Casoy J, Correia T, Freitas LA, Pimentel K, Athayde C (2008) The effect of oral contraceptives on aromatase expression in the eutopic endometrium of patients with endometriosis. Gynecol Endocrinol 24:123PubMedCrossRef

40.

Maia H Jr, Casoy J, Valente Filho J (2009) Is aromatase expression in the endometrium the cause of endometriosis and related infertility? Gynecol Endocrinol 25:253–257PubMedCrossRef

41.

Oettel M, Breitbarth H, Elger W et al (1999) The pharmacological profile of dienogest. Eur J Contracept Reprod Health Care 4:2–13CrossRef

42.

Moore C, Carol W, Graser T, Mellinger U, Walter F (1999) Influence of dienogest on ovulation in young fertile women. Clin Drug Invest 18:271–278CrossRef

43.

Horie S, Harada T, Mitsunari M, Taniguchi F, Iwabe T, Terakawa N (2005) Progesterone and progestational compounds attenuate tumor necrosis factor alpha-induced interleukin-8 production via nuclear factor kappa B inactivation in endometriotic stromal cells. Fertil Steril 83:1530–1535PubMedCrossRef

44.

Herkert O, Kuhl H, Sandow J, Busse R, Schini-Kerth VB (2001) Sex steroids used in hormonal treatment increase vascular procoagulant activity by inducing thrombin receptor (PAR-1) expression: role of the glucocorticoid receptor. Circulation 104:2826–2831PubMedCrossRef

45.

Köhler G, Faustmann TA, Gerlinger C, Seitz C, Mueck AO (2011) A dose-ranging study to determine the efficacy and safety of 1, 2, and 4 mg of dienogest daily for endometriosis. Erratum in: Int J Gynaecol Obstet 112:257CrossRef

46.

Evers LH, Dunselman GA, Land JA, Bouckaert PX (1998) Endometriosis: prevention of recurrence. In: Kempers RD, Cohen J, Haney AF, Younger JB (eds) Fertility and reproduction medicine, vol 1183. Excerpta medica, International congress series, Amsterdam, pp 387–396

47.

Vercellini P, Somigliana E, Daguati R et al (2009) The second time around: reproductive performance after repetitive versus primary surgery for endometriosis. Fertil Steril 92:1253–1255PubMedCrossRef

48.

Vercellini P, Somigliana E, Vigano’ P et al (2009) Surgery for endometriosis-associated infertility: a pragmatic approach. Hum Reprod 24:254–269PubMedCrossRef

49.

Vercellini P, Somigliana E, Vigano’ P et al (2009) The effect of second-line surgery on reproductive performance of women with recurrent endometriosis. Acta Obstet Gynecol Scand 88:1074–1082PubMedCrossRef

50.

Missmer SA, Hankinson SE, Spiegelman D et al (2004) Reproductive history and endometriosis among premenopausal women. Obstet Gynecol 104:965–974PubMedCrossRef

Titel: Oral contraceptives in the prevention of endometrioma recurrence: does the different progestins used make a difference?
verfasst von: Gaspare Cucinella
Roberta Granese
Gloria Calagna
Alessandro Svelato
Salvatore Saitta
Gabriele Tonni
Pasquale De Franciscis
Nicola Colacurci
Antonino Perino
Publikationsdatum: 01.10.2013
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Gynecology and Obstetrics / Ausgabe 4/2013
Print ISSN: 0932-0067
Elektronische ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-013-2841-9

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.

Newsletter bestellen

Springer Medizin

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