Oral Estroprogestins after Laparoscopic Surgery to Excise Endometriomas: Continuous or Cyclic Administration? Results of a Multicenter Randomized Study

Riccardo Marana, L Muzii, F Maneschi, M. G Porpora, E Zupi, F Bellati, R Angioli, P. Benedetti Panici

Risultato della ricerca: Contributo in rivistaArticolo in rivista

31 Citazioni (Scopus)

Abstract

Study Objective: To evaluate continuous (CON) compared with cyclic (CYC) administration of combined oral estroprogestins for 6 months after laparoscopic excision of ovarian endometriomas associated with pain. Design: Multicenter, prospective, randomized trial (Canadian Task Force classification I). Setting: Tertiary care university hospitals. Patients: Fifty-seven women aged 18 to 40 years with ovarian endometriomas associated with moderate to severe pelvic pain who underwent laparoscopic excision of the disease. Interventions: Patients were randomized to receive postoperative estroprogestins for 6 months, administered as either a CON or CYC regimen. Measurements and Main Results: At 3, 6, 12, and 24 months postoperatively, patients were evaluated for recurrence of endometriomas (defined as cysts >3 cm in greatest diameter) using ultrasonography, for recurrence of pain using a visual analog scale, and for patient satisfaction. After a minimum follow-up of 12 months (mean, 22 months), at intent-to-treat analysis, no endometrioma recurrence was observed in the CON group, whereas there was recurrence in 1 patient (4%) in the CYC group. Pain recurred in 5 and 9 patients, respectively (17% vs 32%; p = .23). Compared with pretreatment values, pain scores improved in both groups, with no significant difference between the 2 groups. Most patients in both groups were either satisfied or very satisfied, with no significant difference between treatment groups. However, compared with the CYC group, significantly more patients in the CON group experienced moderate to severe adverse effects, and therapy was discontinued (41% vs 14%; p = .03). Conclusions: Although both regimens were equally effective insofar as postoperative pain and recurrence of endometrioma, when compared with the CYC regimen, the CON regimen seems to be associated with significantly more adverse effects and discontinuation rates. © 2011 AAGL.
Lingua originaleEnglish
pagine (da-a)173-178
Numero di pagine6
RivistaJournal of Minimally Invasive Gynecology
Volume18
DOI
Stato di pubblicazionePubblicato - 2011

Keywords

  • Adult
  • Drug Administration Schedule
  • Drug Combinations
  • Endometriosis
  • Ethinyl Estradiol
  • Female
  • Gynecologic Surgical Procedures
  • Humans
  • Laparoscopy
  • Norpregnenes
  • Ovarian Diseases
  • Pain
  • Pain Measurement
  • Patient Satisfaction
  • Prospective Studies
  • Recurrence
  • Treatment Outcome
  • article
  • breakthrough bleeding
  • desogestrel plus ethinylestradiol, adult
  • disease association
  • disease severity
  • drug efficacy
  • drug withdrawal
  • echography
  • endometrium tumor
  • female
  • follow up
  • headache
  • human
  • laparoscopic surgery
  • major clinical study
  • multicenter study
  • patient satisfaction
  • pelvis pain syndrome
  • postoperative pain
  • prospective study
  • randomized controlled trial
  • recurrence risk
  • scoring system
  • treatment outcome
  • visual analog scale, Adolescent

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