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Continuous versus cyclic use of oral contraceptives after surgery for symptomatic endometriosis: a prospective cohort study. Fertil Steril 2013; 100:1337-42. [DOI: 10.1016/j.fertnstert.2013.07.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 06/29/2013] [Accepted: 07/09/2013] [Indexed: 01/24/2023]
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53
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Somigliana E, Vercellini P, Vigano P, Benaglia L, Busnelli A, Fedele L. Postoperative medical therapy after surgical treatment of endometriosis: from adjuvant therapy to tertiary prevention. J Minim Invasive Gynecol 2013; 21:328-34. [PMID: 24157566 DOI: 10.1016/j.jmig.2013.10.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 10/15/2013] [Accepted: 10/15/2013] [Indexed: 01/03/2023]
Abstract
The high rate of disease recurrence after surgery is critical and frustrating for women with endometriosis. Adjuvant treatments using a 3- to 6-months course of hormone therapy after surgery have been extensively investigated during the last 2 decades; however, results have been unsatisfactory, primarily because the benefits of hormone therapy rapidly vanish once treatment is discontinued. The protective effect is limited to the period of use. Accordingly, it is recognized that suppressive hormone therapy after surgery markedly prevents recurrent episodes only if given over the long term. The emerging view is that estroprogestins do not ameliorate the effects of surgery but demonstrate tertiary prevention of the disease. They prevent ovulation and reduce retrograde menstrual flow, two crucial events in the pathogenesis of endometriosis. The available literature strongly supports the benefits of prolonged administration of estroprogestins after surgery in preventing recurrence of endometriomas and dysmenorrhea. In contrast, data on dyspareunia and nonmenstrual pelvic pain remain scanty and unconvincing, and there is no information about recurrence of other forms of endometriosis such as peritoneal implants and adhesions. Overall, estroprogestin therapy after surgery to treat endometriosis should be recommended in women who do not seek to become pregnant. Further evidence is warranted to better delineate the beneficial effects of this emerging but convincing strategy.
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Affiliation(s)
| | - Paolo Vercellini
- Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Paola Vigano
- Obstetrics and Gynecology Unit, Scientific Institute San Raffaele, Milan, Italy
| | - Laura Benaglia
- Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Busnelli
- Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Luigi Fedele
- Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Università degli Studi di Milano, Milan, Italy
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54
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Endometrioma: From Pathogenesis to Clinical Management. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2013. [DOI: 10.5301/je.5000163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
An endometrioma (OMA) is the localization of endometriosis in ovary, and it most often develops as a cyst. The pathogenesis of OMA is still an open question and controversial; a cystic hemorrhagic corpus luteum may be a prerequisite, occurring as a transition to an endometriotic cyst. Inversion and progressive invagination of the ovarian cortex after the accumulation of menstrual debris derived from bleeding of superficial endometriotic implants, located on the ovarian surface and adherent to the peritoneum, is another hypothesis. Gene studies show that WNT4 and FN1 are predisposing genes for OMA development. A role of environmental toxicants in the development of OMA is also under investigation; dioxins and dioxin-like compounds (DLCs), interacting with steroid receptors, are possible factors. Even if women with endometriosis have a 1.5 times greater lifetime risk to develop an ovarian carcinoma, an OMA is not to be considered a preneoplastic lesion. The clinical management of OMAs is complex and should be individualized. Ultrasounds and magnetic resonance imaging (MRI) are sensitive but not specific for diagnosis. Treatment is influenced by patient age, desire for pregnancy, pain severity, cyst dimensions and characteristics (unilateral/bilateral), coexistence of deep endometriosis, previous gynecological or obstetrical history and previous surgery. Laparoscopic surgery is considered the treatment of choice in cases of infertile patients with a large OMA or pain, and in patients not responding to medical therapy. It should be performed with proper techniques by trained surgeons to decrease the damage to the remaining ovarian tissue, and to maintain the ovarian reserve after surgery. A medical hormonal and nonhormonal treatment is used for asymptomatic and/or pain-associated OMA (progestins, estroprogestins and antiinflammatory drugs). Considering the relative high recurrence rate after surgery, a medical treatment should be offered.
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Ouchi N, Akira S, Mine K, Ichikawa M, Takeshita T. Recurrence of ovarian endometrioma after laparoscopic excision: Risk factors and prevention. J Obstet Gynaecol Res 2013; 40:230-6. [DOI: 10.1111/jog.12164] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 04/18/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Nozomi Ouchi
- Department of Obstetrics and Gynecology; Nippon Medical School; Tokyo Japan
| | - Shigeo Akira
- Department of Obstetrics and Gynecology; Nippon Medical School; Tokyo Japan
| | - Katsuya Mine
- Department of Obstetrics and Gynecology; Nippon Medical School; Tokyo Japan
| | - Masao Ichikawa
- Department of Obstetrics and Gynecology; Nippon Medical School; Tokyo Japan
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Campo S, Campo V, Gambadauro P. Is a positive family history of endometriosis a risk factor for endometrioma recurrence after laparoscopic surgery? Reprod Sci 2013; 21:526-31. [PMID: 24026309 DOI: 10.1177/1933719113503413] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A total of 148 patients were followed up for an average of 30.1 ± 17 months following to laparoscopic excision of ovarian endometriomas by a single surgical team. Bivariate and multivariate analyses were used to investigate the association between endometrioma recurrence and several factors, age, body mass index, family history, cyst diameter, number and location, adhesions or peritoneal implants, occurrence of spillage, postoperative treatment with gonadotropin-releasing hormone agonist, or pregnancies. The overall recurrence rate of the endometriomas was 18.2%. At bivariate analysis, recurrence rate was significantly higher in patients with a positive family history of endometriosis (40% vs 14.8%). Recurrence was also more frequent, albeit nonsignificantly, in patients with a history of dysmenorrhea, intraoperative spillage, and postoperative hormonal suppression. At multivariate analysis with logistic regression, a positive family history of endometriosis was the only variable independently associated with endometrioma recurrence following laparoscopic removal (odds ratio 3.245; 95% confidence interval: 1.090-9.661).
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Affiliation(s)
- Sebastiano Campo
- 1Institute of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
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Ulrich U, Buchweitz O, Greb R, Keckstein J, von Leffern I, Oppelt P, Renner SP, Sillem M, Stummvoll W, Schweppe KW. Interdisciplinary S2k Guidelines for the Diagnosis and Treatment of Endometriosis: Short Version - AWMF Registry No. 015-045, August 2013. Geburtshilfe Frauenheilkd 2013; 73:890-898. [PMID: 24771938 PMCID: PMC3975317 DOI: 10.1055/s-0033-1350810] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- U Ulrich
- Klinik für Gynäkologie und Geburtshilfe, Martin-Luther-Krankenhaus, Berlin
| | | | - R Greb
- Kinderwunschzentrum Dortmund, Dortmund
| | - J Keckstein
- Abteilung für Gynäkologie und Geburtshilfe, Landeskrankenhaus, Villach
| | - I von Leffern
- Klinik für Gynäkologie und Geburtshilfe, Albertinen-Krankenhaus, Hamburg
| | - P Oppelt
- Abteilung für Gynäkologie und Geburtshilfe, Landesfrauen- und Kinderklinik, Linz
| | - S P Renner
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - M Sillem
- Praxisklinik am Rosengarten, Mannheim
| | - W Stummvoll
- vormals Abteilung für Gynäkologie, Krankenhaus der Barmherzigen Schwestern, Linz
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58
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Berlanda N, Morini M, Dridi D, de Braud L, Bracco B, Vercellini P. Effect of Long-Term Use of Hormones on Endometriomas. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2013. [DOI: 10.1007/s13669-013-0053-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Oral contraceptives in the prevention of endometrioma recurrence: does the different progestins used make a difference? Arch Gynecol Obstet 2013; 288:821-7. [DOI: 10.1007/s00404-013-2841-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 04/01/2013] [Indexed: 10/27/2022]
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Morelli M, Sacchinelli A, Venturella R, Mocciaro R, Zullo F. Postoperative administration of dienogest plus estradiol valerate versus levonorgestrel-releasing intrauterine device for prevention of pain relapse and disease recurrence in endometriosis patients. J Obstet Gynaecol Res 2013; 39:985-90. [DOI: 10.1111/jog.12030] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 11/08/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Michele Morelli
- Department of Obstetrics and Gynecology; ‘Magna Graecia’ University; Catanzaro Italy
| | - Angela Sacchinelli
- Department of Obstetrics and Gynecology; ‘Magna Graecia’ University; Catanzaro Italy
| | - Roberta Venturella
- Department of Obstetrics and Gynecology; ‘Magna Graecia’ University; Catanzaro Italy
| | - Rita Mocciaro
- Department of Obstetrics and Gynecology; ‘Magna Graecia’ University; Catanzaro Italy
| | - Fulvio Zullo
- Department of Obstetrics and Gynecology; ‘Magna Graecia’ University; Catanzaro Italy
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Sengoku K, Miyamoto T, Horikawa M, Katayama H, Nishiwaki K, Kato Y, Kawanishi Y, Saijo Y. Clinicopathologic risk factors for recurrence of ovarian endometrioma following laparoscopic cystectomy. Acta Obstet Gynecol Scand 2013. [DOI: 10.1111/aogs.12051] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Kazuo Sengoku
- Department of Obstetrics and Gynecology; Asahikawa Medical University; Asahikawa; Hokkaido; Japan
| | - Toshinobu Miyamoto
- Department of Obstetrics and Gynecology; Asahikawa Medical University; Asahikawa; Hokkaido; Japan
| | - Michiharu Horikawa
- Department of Obstetrics and Gynecology; Asahikawa Medical University; Asahikawa; Hokkaido; Japan
| | - Hideto Katayama
- Department of Obstetrics and Gynecology; Asahikawa Medical University; Asahikawa; Hokkaido; Japan
| | - Kunihiko Nishiwaki
- Department of Obstetrics and Gynecology; Asahikawa Medical University; Asahikawa; Hokkaido; Japan
| | - Yasuhito Kato
- Department of Obstetrics and Gynecology; Asahikawa Medical University; Asahikawa; Hokkaido; Japan
| | - Yasuyuki Kawanishi
- Department of Health Science; Asahikawa Medical University; Asahikawa; Hokkaido; Japan
| | - Yasuaki Saijo
- Department of Health Science; Asahikawa Medical University; Asahikawa; Hokkaido; Japan
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Maccagnano C, Pellucchi F, Rocchini L, Ghezzi M, Scattoni V, Montorsi F, Rigatti P, Colombo R. Ureteral Endometriosis: Proposal for a Diagnostic and Therapeutic Algorithm with a Review of the Literature. Urol Int 2013; 91:1-9. [DOI: 10.1159/000345140] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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VERCELLINI PAOLO, DE MATTEIS SARA, SOMIGLIANA EDGARDO, BUGGIO LAURA, FRATTARUOLO MARIAPINA, FEDELE LUIGI. Long-term adjuvant therapy for the prevention of postoperative endometrioma recurrence: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 2012; 92:8-16. [DOI: 10.1111/j.1600-0412.2012.01470.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Maccagnano C, Pellucchi F, Rocchini L, Ghezzi M, Scattoni V, Montorsi F, Rigatti P, Colombo R. Diagnosis and treatment of bladder endometriosis: state of the art. Urol Int 2012; 89:249-58. [PMID: 22813980 DOI: 10.1159/000339519] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The bladder is the most common affected site in urinary tract endometriosis, being diagnosed during gynecologic follow-up. The surgical urological treatment might lead to good results. STUDY OBJECTIVE To define the state of the art in the diagnosis and treatment of bladder endometriosis. METHODS We performed a literature review by searching the MEDLINE database for articles published between 1996 and 2011, limiting the searches to the words: urinary tract endometriosis, bladderendometriosis, symptoms, diagnosis and treatment. RESULTS Deep pelvic endometriosis usually involves the urinary system, with the bladder being affected in 85% of cases. The diagnosis has to be considered as a step-by-step procedure. Currently, the treatment is usually surgical, consisting of either transurethral resection or partial cystectomy, and eventually associated with hormonal therapy. The hormonal therapy alone counteracts only the stimulus of endometriotic tissue proliferation, with no effects on the scarring caused by this tissue. The overall recurrence rate is about 30% for combined therapies and about 35% for the hormonal treatment alone. CONCLUSIONS The bladder is the most common affected site in urinary tract endometriosis. Most of the time, this condition is diagnosed because of the complaint of urinary symptoms during gynecologic follow-up procedures for a deep pelvic endometriosis: a close collaboration between the gynecologist and the urologist is advisable, especially in highly specialized centers. The surgical urological treatment might lead to good results in terms of patients' compliance and prognosis.
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Affiliation(s)
- Carmen Maccagnano
- Department of Urology, San Raffaele Scientific Institute, Milan, Italy.
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65
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Gelbaya TA, Nardo LG. Evidence-based management of endometrioma. Reprod Biomed Online 2011; 23:15-24. [DOI: 10.1016/j.rbmo.2010.11.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 09/25/2010] [Accepted: 11/11/2010] [Indexed: 11/15/2022]
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66
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Somigliana E, Benaglia L, Vercellini P, Paffoni A, Ragni G, Fedele L. Recurrent endometrioma and ovarian reserve: biological connection or surgical paradox? Am J Obstet Gynecol 2011; 204:529.e1-5. [PMID: 21419388 DOI: 10.1016/j.ajog.2011.01.053] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 01/19/2011] [Accepted: 01/24/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Cumulative evidence supports the view that ovarian endometriomas originate from ovulatory events and that the ovarian reserve is reduced following surgery. On these bases, we have hypothesized that the risk of recurrence may be related to the residual ovarian reserve of the operated ovary. STUDY DESIGN We retrospectively selected 45 women scheduled for in vitro fertilization who previously underwent surgical excision of monolateral endometriomas and compared ovarian responsiveness in those who did (n = 24) and did not (n = 21) have a recurrent endometrioma. RESULTS In the intact ovaries, the mean ± SD number of codominant follicles in women with and without recurrences was 3.5 ± 1.7 and 3.7 ± 2.2, respectively (P = NS). In the affected ovaries, the mean ± SD number of follicles in gonads with and without recurrences was 2.5 ± 2.3 and 1.1 ± 1.5, respectively (P < .05). CONCLUSION Ovarian responsiveness is higher in gonads that developed recurrent endometriomas.
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Abstract
Over the past 50 years hormonal contraceptives have gradually developed to be cost-effective medical treatment modalities for primary and secondary therapy of endometriosis/adenomyosis. This is particularly true for the various estrogen/progestogen combinations as monophasic - particularly progestogen-dominant - preparations in cyclic, long-cyclic and continuous treatment forms. An alternative is the progestogen-only therapy used continuously. Therapeutic effects have been shown for peritoneal, ovarian and deep-infiltrating endometriosis as well as for adenomyosis. An individualized, medical long-term treatment concept to control endometriosis/adenomyosis-related symptoms, endometriosis/adenomyosis development and minimizing the recurrence rate needs to be further studied in women, who do not desire to become pregnant.
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Vercellini P, Crosignani P, Somigliana E, Vigano P, Frattaruolo MP, Fedele L. 'Waiting for Godot': a commonsense approach to the medical treatment of endometriosis. Hum Reprod 2010; 26:3-13. [DOI: 10.1093/humrep/deq302] [Citation(s) in RCA: 145] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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69
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Lee DY, Bae DS, Yoon BK, Choi D. Post-operative cyclic oral contraceptive use after gonadotrophin-releasing hormone agonist treatment effectively prevents endometrioma recurrence. Hum Reprod 2010; 25:3050-4. [DOI: 10.1093/humrep/deq279] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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70
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Somigliana E, Vercellini P, Vigano' P, Benaglia L, Crosignani PG, Fedele L. Non-invasive diagnosis of endometriosis: the goal or own goal? Hum Reprod 2010; 25:1863-8. [DOI: 10.1093/humrep/deq141] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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