Preventive therapeutic options for postoperative recurrence of ovarian endometrioma: gonadotropin-releasing hormone agonist with or without levonorgestrel intrauterine system insertion

Arch Gynecol Obstet. 2021 Feb;303(2):533-539. doi: 10.1007/s00404-020-05843-5. Epub 2020 Oct 26.

Abstract

Purpose: Here, we compared endometrioma recurrence rates in patients who have undergone a laparoscopic cystectomy and treated with a gonadotropin-releasing hormone agonist (GnRHa) alone or a GnRHa combined with a levonogestrel intrauterine system (LND-IUS).

Methods: We enrolled endometrioma patients who underwent laparoscopic cyst enucleation and divided them into two groups according to postoperative management: GnRHa alone and GnRHa in combination with LND-IUS. We compared preoperative history, perioperative parameters, postoperative endometrioma recurrence, and symptoms between these two groups.

Results: A total of 320 patients were included in the final analysis. With a median 84.6 months of follow-up, we detected significant differences between the two groups with respect to age at surgery (31.6 ± 4.8 vs. 37.6 ± 4.2 years, χ2 = 1.978, p < 0.001), gravida (0 vs. 2, χ2 = 4.391, p < 0.001), parity (0 vs. 1, χ2 = 0.035, p < 0.001), body mass index (21.0 ± 2.5 vs. 21.9 ± 2.4, χ2 = 0.0096, p = 0.009), r-AFS score (48 vs. 64, χ2 = 4.888, p = 0.001), and operation time (60 vs. 75 min, χ2 = 9.119, p = 0.003). Patients treated with both GnRHa and LND-IUS achieved significantly less endometrioma recurrence (23.6 vs. 11.5%, χ2 = 5.202, p = 0.023) and higher rates of pain remission (92.1 vs. 100%, χ2 = 6.511, p = 0.011), while those with GnRHa alone suffered more recurrent and painful symptoms (χ2 = 9.280, p = 0.026). Multivariate analysis using a Cox regression demonstrated that combined GnRHa and LNG-IUS treatment correlated with a decreased endometrioma recurrence rate after laparoscopic cystectomy (RR 0.369, 95% CI 0.182-0.749, p = 0.006).

Conclusions: Combination treatment of GnRHa and LNG-IUS exhibited superior pain relief and recurrence prevention among endometrioma patients after fertility-sparing surgery. Thus, combination treatment is a preferable long-term option for patients without intent for pregnancy in the near future.

Keywords: GnRHa; LNG-IUD; Laparoscopic cystectomy; Ovarian endometriosis; Recurrence.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Combined Modality Therapy
  • Contraceptive Agents, Female / administration & dosage*
  • Contraceptive Agents, Female / therapeutic use
  • Endometriosis / pathology
  • Endometriosis / surgery*
  • Female
  • Gonadotropin-Releasing Hormone / administration & dosage*
  • Gonadotropin-Releasing Hormone / agonists
  • Gonadotropin-Releasing Hormone / therapeutic use
  • Humans
  • Intrauterine Devices, Medicated*
  • Levonorgestrel / administration & dosage*
  • Levonorgestrel / therapeutic use
  • Neoplasm Recurrence, Local / drug therapy*
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Recurrence, Local / prevention & control*
  • Postoperative Period
  • Secondary Prevention
  • Treatment Outcome

Substances

  • Contraceptive Agents, Female
  • Gonadotropin-Releasing Hormone
  • Levonorgestrel