Prevention of endometriotic cyst recurrence with continuous oral contraceptives after laparoscopic surgery

Prevention of endometriotic cyst recurrence with continuous oral

contraceptives after laparoscopic surgery

H. Maia Jr, G. Coelho, J. Valente Filho, C. Athayde, I.C. Barbosa, E.M.


Centro de Pesquisa e Assistência em Reproduçáo Humana – CEPARH,

Salvador, Bahia, Brazil

Objectives: Endometriotic cysts recur following laparoscopic surgery

in 5 – 35% of cases due to the reestablishment of monthly menstrual bleeding,

which carries viable endometrial cells into the peritoneal cavity. The objective

of this study was therefore to evaluate the effects of suppressing ovulation and

menstrual bleeding on the recurrence of endometriotic cysts through the

continuous use of oral contraceptives following laparoscopic surgery.

Material & Methods: In this study, the efficacy of the continuous

administration of an oral contraceptive combination was evaluated in an open

study carried out over a two-year period. The treated arm of the study consisted

of 20 patients with the diagnosis of endometriotic cyst, who were submitted to

video-laparoscopic surgery and who were not planning pregnancy. These patients

had either bilateral (n=8), left side (n=8) or right side (n=4) endometriomas.

Transvaginal sonography with color Doppler was carried out in all cases prior to

surgery and every six months thereafter. Treatment regimen consisted of the

continuous administration of 30 mcg of ethinyl-estradiol and 75 mcg of gestodene

(Gestinol, Libbs, Brazil) for two years. Eighteen patients with ovarian

endometriomas submitted to laparoscopic surgery, who did not wish to become

pregnant and who were using barrier methods as their sole form of contraception,

comprised a control group. All control patients had transvaginal sonograms

before surgery and at six-month intervals for two years following surgery. The

criteria for diagnosing a recurrence of endometriosis were the resumption of

symptoms and sonographic detection of endometriotic cysts.

Results: In the control group, 4/18 (22%) patients had a recurrence of

endometriotic cysts and the return of dysmenorrhea by the end of the first year.

In the second year, three more patients developed endometriotic cysts as

detected by transvaginal sonography, giving a cumulative failure rate of 38%. In

contrast, in patients using continuous oral contraceptives, there were no

recurrences of ovarian endometriotic cysts or symptomatology in the 18 patients

that completed the treatment period. No patients abandoned the study because of

side effects of the treatment. The only two subjects who stopped the medication

in the second year did so because they wished to become pregnant.

Conclusion: These results indicate the necessity to suppress ovulation

and menstrual bleeding following surgery in patients with endometriotic cysts in

order to prevent their recurrence.

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