Postoperative maintenance levonorgestrel-releasing intrauterine system and endometrioma recurrence: a randomized controlled study

Chen, Yi Jen; Hsu, Teh Fu; Huang, Ben; Tsai, Hsiao Wen; Chang, Yu-Lung; Wang, Peng Hui

doi:10.1016/j.ajog.2017.02.008

Cited by 62 publications

(51 citation statements)

References 32 publications

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“…4,5 However, only a few studies have evaluated the long-term effectiveness of the LNG-IUS for preventing endometrioma recurrence, and the effects of LNG-IUS as a maintenance therapy for endometriosis after surgery remain unclear. [12][13][14] In present study, the mean age of LNG-IUS group which might be an affecting factor of recurrence of endometriosis was higher than dienogest group. 15 Although it is difficult to compare of efficacy between dienogest and LNG-IUS due to difference of the mean age, LNG-IUS treatment in patients with endometriosis is Figure 2 Endometriosis recurrence analyses using Kaplan-Meier tests to assess the differences between three groups.…”

Section: Discussionmentioning

confidence: 39%

“…Some patients treated with LNG‐IUS were spontaneously expulsed. In the present study, recurrence was defined as a reappearance of endometrioma with a diameter >2.5 cm on ultrasound …”

Section: Methodsmentioning

confidence: 99%

“…In the present study, recurrence was defined as a reappearance of endometrioma with a diameter >2.5 cm on ultrasound. 12 For one-way analysis of variance for age, body mass index, rASRM score, CA-125 value and recurrence rate of each group were used. If significant differences were found, subsequent between-group differences were confirmed using the Dunnett test.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Comparison of the efficacy of diegnogest and levonorgestrel‐releasing intrauterine system after laparoscopic surgery for endometriosis

Lee

Jung

Song

et al. 2018

J of Obstet and Gynaecol

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Section: Discussionmentioning

confidence: 39%

“…Some patients treated with LNG‐IUS were spontaneously expulsed. In the present study, recurrence was defined as a reappearance of endometrioma with a diameter >2.5 cm on ultrasound …”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of the efficacy of diegnogest and levonorgestrel‐releasing intrauterine system after laparoscopic surgery for endometriosis

Lee

Jung

Song

et al. 2018

J of Obstet and Gynaecol

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show abstract

“…If the higher incidence of recurrence is solely due to an observation bias, or that OMA is more likely to recur cannot be answered by the current study. A recent randomized controlled study evaluating levonorgestrel-IUD reported 25%-37.5% OMA recurrence [27]. However, recurrent surgery on the ovary is related to ovarian reserve damage [28] and recurrent surgery for endometriosis in general is related to stress, complications, as well as personal and social costs.…”

Section: Discussionmentioning

confidence: 99%

Recurrence Patterns after Surgery in Patients with Different Endometriosis Subtypes: A Long-Term Hospital-Based Cohort Study

Nirgianakis

McKinnon

et al. 2020

JCM

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Recurrence of endometriosis after surgery constitutes a serious challenge. Whether there is an evolution of lesion subtypes with each recurrence and whether certain lesions subtypes tend to recur faster than others is not adequately addressed. Medical records of all patients who underwent surgery for endometriosis between 1997 and 2018 in the Department of Gynecology and Obstetrics, University of Bern, were reviewed. Inclusion criteria was surgically confirmed endometriosis recurrence, defined as a subsequent surgery for endometriosis after a previous complete surgical excision of endometriosis lesions. Three subtypes of endometriosis were defined: superficial peritoneal endometriosis (SUP), ovarian endometrioma (OMA), and deep infiltrating endometriosis (DIE). Time to recurrence and variation in endometriosis subtype between the first and recurrent surgeries were the primary outcome measures. Out of the 322 patients with recurrent surgery that were identified, for 234 of them, the endometriosis subtype at first surgery was confirmed and classified (SUP = 56, OMA = 124, DIE = 54). No statistically significant difference was found for time to recurrence between lesion subtypes. SUP compared to the other groups had a higher possibility of presenting with SUP at recurrence (Odds Ratio (OR): 3.65, 95% confidence interval (CI): 1.74-7.51) and OMA compared to the other groups had a higher possibility of presenting with OMA at recurrence (OR: 3.72, 95% CI: 2.04-6.74). Nevertheless, a large number of SUP patients subsequently presented with OMA (10/56: 17.9%) or DIE (27/56: 48.2%) lesions at recurrence. Similarly, a large number of OMA patients subsequently presented with DIE (49/124: 39.5%) lesions at recurrence. In conclusion, although SUP and OMA patients compared to the others are more likely to present with the same subtype at recurrence, increasing lesion subtype severity occurs in a substantial proportion of patients. Time to recurrence is independent from the lesion subtype at first surgery.Laparoscopic surgery is associated with decreased overall pain, both at 6 and 12 months after surgery [6]. However, despite complete removal of endometriotic tissue, a high proportion of patients will require additional surgery due to endometriosis recurrence. In a recent UK population-based report, 48% of patients with endometriosis received surgical treatment. Approximately one-fifth of these patients required further surgical treatment, within three years of the index procedure [7]. Other studies have reported total recurrence rates of 21.5% and 40%-50% at two and five years, respectively [8,9].Endometriosis lesions are a heterogenous group of lesions that are currently split into three subtypes based on the location and infiltration depth: superficial peritoneal endometriosis (SUP), ovarian endometrioma (OMA), and deep infiltrating endometriosis (DIE) [10,11]. Although patients with SUP may suffer from pelvic pain, OMA and DIE generally cause heavier symptoms, have more serious long-term complications, are more difficult t...

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“…The most common side effects are menstrual abnormalities, amenorrhea, dysmenorrhea, oligomenorrhea, headaches, and acne. [82][83][84] GnRH agonists act by prolonged activation of GnRH receptors responsible for desensitization and consequently suppression of gonadotropin secretion, inducing pseudomenopausal state. Experts studied leuprolide acetate 3.75 mg monthly depot formulation, which was associated with marked improvement in moderate to severe pain symptoms but with rapid recurrence following drug discontinuation.…”

Section: Medical Therapymentioning

confidence: 99%

<p>Bowel Endometriosis: Current Perspectives on Diagnosis and Treatment</p>

Habib¹,

Centini²,

Lazzeri³

et al. 2020

IJWH

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Endometriosis is a chronic condition primarily affecting young women of reproductive age. Although some women with bowel endometriosis may be asymptomatic patients typically report a myriad of symptoms such as alteration in bowel habits (constipation/diarrhoea) dyschezia, dysmenorrhoea and dyspareunia in addition to infertility. To date, there are no clear guidelines on the evaluation of patients with suspected bowel endometriosis. Several techniques have been proposed including transvaginal and/or transrectal ultrasonography, magnetic resonance imaging, and double-contrast barium enema. These different imaging modalities provide greater information regarding presence, location and extent of endometriosis ensuring patients are adequately informed whilst also optimizing preoperative planning. In cases where surgical management is indicated, surgery should be performed by experienced surgeons, in centres with access to multidisciplinary care. Treatment should be tailored according to patient symptoms and wishes with a view to excising as much disease as possible, whilst at the same time preserving organ function. In this review article current perspectives on diagnosis and management of bowel endometriosis are discussed.

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Postoperative maintenance levonorgestrel-releasing intrauterine system and endometrioma recurrence: a randomized controlled study

Abstract: Long-term maintenance therapy using a levonorgestrel-releasing intrauterine system is not effective for preventing endometrioma recurrence.

Cited by 62 publications

References 32 publications

Comparison of the efficacy of diegnogest and levonorgestrel‐releasing intrauterine system after laparoscopic surgery for endometriosis

Comparison of the efficacy of diegnogest and levonorgestrel‐releasing intrauterine system after laparoscopic surgery for endometriosis

Recurrence Patterns after Surgery in Patients with Different Endometriosis Subtypes: A Long-Term Hospital-Based Cohort Study

<p>Bowel Endometriosis: Current Perspectives on Diagnosis and Treatment</p>

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