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

Abstract

We read the study performed by Chen et al 1 with much interest. In this randomized controlled study, the authors evaluated whether a levonorgestrelreleasing intrauterine system can prevent the recurrence of endometrioma. Interestingly, the main results highlighted that using a levonorgestrel-releasing intrauterine system is not effective for preventing endometrioma recurrence but significantly reduced the recurrence of dysmenorrheal, pelvic pain, and the CA-125 level. Although these findings are very important to guide doctors' choices in the clinic, we would like to raise one question. As reported in many studies, the American Society for Reproductive Medicine (ASRM) score is the most significant risk factor for predicting endometrioma recurrence. For example, in a study containing 352 cases, Tobiume et al 2 found that a high ASRM score was the unique predictor of endometrioma recurrence. Consistently, in another study of 310 patients with endometrioma who accepted surgery, the intraoperative ASRM score was also demonstrated to be an important risk factor for disease recurrence. 3 Similarly, Yanase et al evaluated 26 patients with endometrioma treated with dienogest after surgery and reported that all of the 6 patients with endometrioma recurrence were classified to be stage IV (ASRM score). 4 In the study by Chen et al, 1 we noticed that there were 31 patients at stage IV in the intervention group and only 24 in the control group (P ¼ .091), which is not statistically different but can notably affect the final results. Therefore, we suggest the 2 groups should be better balanced and data should be reanalyzed.