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.