Dienogest therapy during the early stages of recurrence of endometrioma might be an alternative therapeutic option to avoid repeat surgeries
The Journal of Obstetrics & Gynecology Research:
An ovarian endometrioma is a cystic mass arising from ectopic endometrial tissue within the ovary. It contains thick, brown, tar-like fluid, which may be referred to as a "chocolate cyst." Endometriomas are often densely adherent to surrounding structures, such as the peritoneum, fallopian tubes, uterus, and bowel.
Endometriosis is a well-recognized gynecological problem which has a spectrum of presentations range from asymptomatic presentation, pain, infertility, to adnexal mass. Endometriosis affects 6-10% of women of reproductive age, from these women, 17-44% have ovarian endometriosis, where there is a chocolate fluid –containing cyst within the ovary with ectopic endometrial tissue lining which is called ovarian endometrioma or chocolate cyst.
TAKE HOME MESSAGE:
The presentation of patients with endometrioma also has the same spectrum of presentation of endometriosis in general, and the clinician should suspect the presence of this condition when he/she feels an adnexal mass.
The transvaginal ultrasounds can diagnosis or roll out the ovarian endometrioma.
In symptomatic patients, the associated symptoms usually guide the choice of treatment, and the management options include medical, surgical, or both.
The presence of endometriomas and the surgical management of them both have a damaging effect on the ovarian function and reserve, this fact creates the debate on the ideal management infertile women.
The recurrence rate after surgical management ranges from 12-30% over a period of 2-5 years follow up and it may be higher if we take into consideration the asymptomatic cases.
The recurrent endometrioma represents a clinical challenge, where the surgery is generally discouraged due to high risk of damage to ovarian reserve; on the other hand, the recurrent endometrioma is associated with a significant risk of unexpected malignancy, particularly in patients older than 40 years.
Progestin has typically used in the treatment of endometriosis in those who are intolerant to combine contraceptive pills. Dienogest is a fourth generation of this group and has been proved to be effective and safe in this indication.
Authors aimed to evaluate whether hormonal therapy immediately after postsurgical recurrence of ovarian endometrioma controls disease progression and can be an alternative therapeutic option to avoid multiple repeat surgeries.
Dienogest is a well-tolerated therapy for recurrent endometrioma with safe side effect profile. It can make the patient pain free and reduce the size of the cyst. Dienogest therapy early after recurrence of postsurgical endometrioma appears to be viable for reducing the risk of repeated surgery.
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Aim
Authors aimed to evaluate whether hormonal therapy immediately after postsurgical recurrence of ovarian endometrioma controls disease progression and can be an alternative therapeutic option to avoid multiple repeat surgeries.
Methods
Study enrolled 146 patients treated for endometrioma at the University Hospital of Kyoto Prefectural University of Medicine between 2009 and 2015. After laparoscopic cystectomy using the stripping technique, opening of cul-de-sac obliterations and complete resection of the deep infiltrating endometriosis lesions, the patients either received no treatment (n = 83), oral contraceptives (OC; n = 32) or dienogest (DNG; n = 27), depending on their medical history. Four patients were excluded because they changed their regimens during the follow-up period. All patients were followed up every 3 months. Patients who developed recurrence of endometrioma immediately received DNG, OC or gonadotropin-releasing hormone agonist.
Results
Overall, 16 patients developed a recurrence of the endometrioma (12 in the nontreatment group, three in the OC group and one in the DNG group). The 11 patients with recurrence were treated with DNG immediately after the diagnosis of recurrent endometrioma. Among them, seven patients continued treatment with DNG (2 mg) for 24 months. After 24 months of treatment with DNG, complete resolution of recurrent endometrioma was achieved in four (57.1%) of seven patients. There was no improvement in the three patients who received OC and one patient who underwent secondary surgery.
Conclusion
DNG therapy early after recurrence of postsurgical endometrioma appears to be viable for reducing the risk of repeated surgery.
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