Abstract
The clinical management of women with deep peritoneal endometriosis remains controversial. The debate focuses mainly on the precise role of hormonal medical treatment and surgery and on the most suitable surgical technique to be used. In particular, considering the risks of second-line surgery, prevention of recurrences after first-line surgery is a priority in this context. Post-surgical medical therapy has been advocated to improve the effectiveness of surgery and prevent recurrences. However, adjuvant therapy, i.e. a short course of 3-6 months of hormonal therapy after surgery, has been proven to be of limited or no benefit for endometriosis in general and for deep peritoneal endometriosis in particular. On the other hand, two cohort studies suggest a beneficial effect of prolonged hormonal therapy after surgery for deep endometriosis. Even if this evidence is too weak to confidently advocate systematic administration of prolonged medical therapy after surgery, we argue in favour of this approach because of the strong association of deep endometriosis with other disease forms. In fact, women operated on for deep endometriosis may also face recurrences of endometriomas, superficial peritoneal lesions and pelvic pain in general. The demonstrated high effectiveness of prolonged postoperative therapy for the prevention of endometriomas' formation and dysmenorrhea recurrence should thus receive utmost consideration in the decision-making process.
| Original language | English |
|---|---|
| Journal | European Journal of Obstetrics, Gynecology and Reproductive Biology |
| DOIs | |
| Publication status | Accepted/In press - Feb 3 2016 |
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Keywords
- Deep
- Endometriosis
- Hormonal treatment
- Surgery
ASJC Scopus subject areas
- Obstetrics and Gynaecology
- Reproductive Medicine
Cite this
Postoperative hormonal therapy after surgical excision of deep endometriosis. / Somigliana, Edgardo; Busnelli, Andrea; Benaglia, Laura; Viganò, Paola; Leonardi, Marta; Paffoni, Alessio; Vercellini, Paolo Pietro.
In: European Journal of Obstetrics, Gynecology and Reproductive Biology, 03.02.2016.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Postoperative hormonal therapy after surgical excision of deep endometriosis
AU - Somigliana, Edgardo
AU - Busnelli, Andrea
AU - Benaglia, Laura
AU - Viganò, Paola
AU - Leonardi, Marta
AU - Paffoni, Alessio
AU - Vercellini, Paolo Pietro
PY - 2016/2/3
Y1 - 2016/2/3
N2 - The clinical management of women with deep peritoneal endometriosis remains controversial. The debate focuses mainly on the precise role of hormonal medical treatment and surgery and on the most suitable surgical technique to be used. In particular, considering the risks of second-line surgery, prevention of recurrences after first-line surgery is a priority in this context. Post-surgical medical therapy has been advocated to improve the effectiveness of surgery and prevent recurrences. However, adjuvant therapy, i.e. a short course of 3-6 months of hormonal therapy after surgery, has been proven to be of limited or no benefit for endometriosis in general and for deep peritoneal endometriosis in particular. On the other hand, two cohort studies suggest a beneficial effect of prolonged hormonal therapy after surgery for deep endometriosis. Even if this evidence is too weak to confidently advocate systematic administration of prolonged medical therapy after surgery, we argue in favour of this approach because of the strong association of deep endometriosis with other disease forms. In fact, women operated on for deep endometriosis may also face recurrences of endometriomas, superficial peritoneal lesions and pelvic pain in general. The demonstrated high effectiveness of prolonged postoperative therapy for the prevention of endometriomas' formation and dysmenorrhea recurrence should thus receive utmost consideration in the decision-making process.
AB - The clinical management of women with deep peritoneal endometriosis remains controversial. The debate focuses mainly on the precise role of hormonal medical treatment and surgery and on the most suitable surgical technique to be used. In particular, considering the risks of second-line surgery, prevention of recurrences after first-line surgery is a priority in this context. Post-surgical medical therapy has been advocated to improve the effectiveness of surgery and prevent recurrences. However, adjuvant therapy, i.e. a short course of 3-6 months of hormonal therapy after surgery, has been proven to be of limited or no benefit for endometriosis in general and for deep peritoneal endometriosis in particular. On the other hand, two cohort studies suggest a beneficial effect of prolonged hormonal therapy after surgery for deep endometriosis. Even if this evidence is too weak to confidently advocate systematic administration of prolonged medical therapy after surgery, we argue in favour of this approach because of the strong association of deep endometriosis with other disease forms. In fact, women operated on for deep endometriosis may also face recurrences of endometriomas, superficial peritoneal lesions and pelvic pain in general. The demonstrated high effectiveness of prolonged postoperative therapy for the prevention of endometriomas' formation and dysmenorrhea recurrence should thus receive utmost consideration in the decision-making process.
KW - Deep
KW - Endometriosis
KW - Hormonal treatment
KW - Surgery
UR - http://www.scopus.com/inward/record.url?scp=84962383354&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84962383354&partnerID=8YFLogxK
U2 - 10.1016/j.ejogrb.2016.03.030
DO - 10.1016/j.ejogrb.2016.03.030
M3 - Article
JO - European Journal of Obstetrics, Gynecology and Reproductive Biology
JF - European Journal of Obstetrics, Gynecology and Reproductive Biology
SN - 0028-2243
ER -