Postoperative management of reproductive-aged patients with endometrioid ovarian cysts

Virivskaya E.V., Bakhtiyarov K.R., Evstratova K.D.

1) “Clinic Semeinaya” (Family Clinic), Family Healthcare Network, Moscow, Russia; 2) Department of Obstetrics, Gynecology, and Perinatology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia, Moscow, Russia; 3) N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia
Objective: To assess the long-term results of hormone treatment in patients after laparoscopic cystectomy for endometrioid ovarian cyst.
Materials and methods: The observational study included 56 reproductive-aged patients after cystectomy for endometrioid cysts. Forty-one (74.4%) patients in Group 1 took dienogest (Zafrilla) at a daily dose of 2 mg. The therapy duration was 24 weeks. Eight (13.9%) patients in Group 2 used Siluette containing dienogest 2 mg for contraception. Seven (11.6%) patients in Group 3 received therapy with gonadotropin-releasing hormone analogues at a dose of 3.75 mg (1 injection) intramuscularly every 28 days for 6 months. A follow-up was continued after 3 and 6 months. The investigators studied the intensity of pain syndrome using a visual analogue scale (VAS) before treatment and during control visits, reproductive outcomes, recurrence of cysts, and side effects (adverse events) of the drugs used.
Results: The intensity of pain syndrome was observed to decrease in all the patients during the performed therapy following 3 and 6 months. The rate of pregnancy onset in Group 1 was comparable to that in the gonadotropin-releasing hormone agonist group (17/41 (41.5%) versus 3/7 (42.8%)). Disease relapse was noted in 3/41 (7.3%) women in Group 1, in 2/8 (25%) patients in Group 2, and in 1/7 (14.2%) in Group 3. Adverse events in the patients of all the groups were not an indication for medication discontinuation, were relieved symptomatically, or stopped at later stages of treatment.
Conclusion: Depending on the reproductive motivations of patients, they used different drugs in each age group. In this case, it is necessary to take into account the tolerability of a particular drug. Dienogest occupies its own niche in the therapy of endometriosis-associated pelvic pain, dysmenorrhea, and dyspareunia as a long-term postoperative therapy in patients with endometrioid ovarian cysts.


endometrioid ovarian cyst
gonadotropin-releasing hormone analogues
adverse events


  1. Shafrir A.L., Farland L.V., Shah D.K., Harris H.R., Kvaskoff M., Zondervan K., Missmer S.A. Risk for and consequences of endometriosis: A critical epidemiologic review. Best Pract. Res. Clin. Obstet. Gynaecol. 2018; 51: 1-15.
  2. Сафронова А.С., Буралкина Н.А., Чупрынин В.Д., Черемин М.М. Прогнозирование репродуктивных исходов у пациенток с глубоким эндометриозом после хирургического лечения. Акушерство и гинекология. 2021; 7: 158-64. [Safronova A.S., Buralkina N.A., Chuprynin V.D., Cheremin M.M. Prediction of reproductive outcomes in patients with deep endometriosis after surgical treatment. Obstetrics and Gynecology. 2021; 7: 158-64. (in Russian)].
  3. Selcuk S., Cam C., Koc N., Kucukbas M., Ozkaya E., Eser A., Karateke A. Evaluation of risk factors for the recurrence of ovarian en- dometriomas. Eur. J. Obstet. Gynecol. Reprod. Biol. 2016; 203: 56-60.
  4. Филиппова Е.С., Козаченко И.Ф., Адамян Л.В., Дементьева В.О. Влияние хирургического лечения эндометриоидных кист яичников на состояние овариального резерва у женщин репродуктивного возраста. Проблемы репродукции. 2018; 24(4): 7180. [Filippova E.S., Kozachenko I.Ph., Adamyan L.V., Dementyeva V.O. Influence of surgical treatment of ovarian endometriomas cysts on ovarian reserve in women of reproductive age. Russian Journal of Human Reproduction. 2018; 24(4): 7180. (in Russian)].
  5. Российское общество акушеров-гинекологов (РОАГ). Клинические рекомендации “Эндометриоз”. 2020. [Russian Society of Obstetricians and Gynecologists (RSOG). Clinical guidelines “Endometriosis. 2020. (in Russian)].
  6. Cecchino G.N., Cozzolino M., Roque M., García-Velasco J.A. Endometrioma and reproductive issues: a well-informed patient may be the driver for change. Minerva Ginecol. 2020; 72(3): 149-56.
  7. Prefumo F., Rossi A.C. Endometriosis, endometrioma, and ART results: current understanding and recommended practices. Best Pract. Res. Clin. Obstet. Gynaecol. 2018; 51: 34-40.
  8. Ярмолинская М.И., Русина Е.И., Хачатурян А.Р., Фролова М.С. Клиника и диагностика генитального эндометриоза. Журнал акушерства и женских болезней. 2016; 65(5): 4-21. [Yarmolinskaya M.I., Rusina E.I., Khachaturyan A.R., Florova M.S. Clinical picture and diagnosis of genital endometriosis. Journal of obstetrics and women’s diseases. 2016; 65(5): 4-21. (in Russian)].
  9. Vercellini P., Crosignani P., Somigliana E. Viganò P., Frattaruolo M.P., Fedele L. ‘Waiting for Godot’: a commonsense approach to the medical treatment of endometriosis. Hum. Reprod. 2011; 26(1): 3-13.
  10. Guo S.W. Recurrence of endometriosis and its control. Hum. Reprod. Update. 2009; 15(4): 441-61.
  11. Iwami N., Kawamata M., Ozawa N., Yamamoto T., Watanabe E., Mizuuchi M. et al. New treatment strategy for endometriosis using progestin-primed ovarian stimulation with dienogest: A prospective cohort study, comparison of dienogest versus dydrogesterone. Reprod. Biol. 2021; 21(1): 100470.

Received 17.11.2022

Accepted 29.11.2022

About the Authors

Elena V. Virivskaya, PhD, leading expert, Clinic Semeynaya,
Kamil R. Bakhtiyarov, Dr. Med. Sci., Professor at the Department of Obstetrics, Gynecology and Perinatology, I.M. Sechenov First Moscow State Medical University,
Ministry of Health of Russia (Sechenov University),, 8-2 Trubetskaya str., Moscow, 119991, Russia.
Kristina D. Evstratova, student, Pirogov Russian National Research Medical University, Ministry of Health of Russia,,
1 Ostrovityanova str., Moscow, 117997, Russia.

Authors’ contributions: Virivskaya E.V., Bakhtiyarov K.R., Evstratova K.D. – concept and design of the investigation; material collection and processing; writing the text; editing.
Conflicts of interest: The authors declare that there are no conflicts of interest.
Funding: The investigation has not been sponsored.
Patient Consent for Publication: All patients provided informed consent for the publication of their data.
For citation: Virivskaya E.V., Bakhtiyarov K.R., Evstratova K.D. Postoperative management
of reproductive-aged patients with endometrioid ovarian cysts.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2022; 12: 140-145 (in Russian)

Similar Articles

By continuing to use our site, you consent to the processing of cookies that ensure the proper functioning of the site.