Postoperative management of reproductive-aged patients with endometrioid ovarian cysts
Objective: To assess the long-term results of hormone treatment in patients after laparoscopic cystectomy for endometrioid ovarian cyst.Virivskaya E.V., Bakhtiyarov K.R., Evstratova K.D.
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.
Keywords
endometrioid ovarian cyst
dienogest
recurrence
pain
gonadotropin-releasing hormone analogues
pregnancy
adverse events
References
- 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. https://dx.doi.org/10.1016/j.bpobgyn.2018.06.001.
- 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. https://dx.doi.org/10.18565/aig.2021.7.158-164. [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)].https://dx.doi.org/10.18565/aig.2021.7.158-164.
- 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. https://dx.doi.org/10.1016/j.ejogrb.2016.05.008.
- 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. https://dx.doi.org/10.17116/repro20182404171. [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)]. https://dx.doi.org/10.17116/repro20182404171.
- Российское общество акушеров-гинекологов (РОАГ). Клинические рекомендации “Эндометриоз”. 2020. [Russian Society of Obstetricians and Gynecologists (RSOG). Clinical guidelines “Endometriosis. 2020. (in Russian)].
- 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. https://dx.doi.org/10.23736/S0026-4784.20.04595-5.
- 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. https://dx.doi.org/10.1016/j.bpobgyn.2018.01.019.
- 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. https://dx.doi.org/10.17816/JOWD6554-21. [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)]. https://dx.doi.org/10.17816/JOWD6554-21.
- 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. https://dx.doi.org/10.1093/humrep/deq302.
- Guo S.W. Recurrence of endometriosis and its control. Hum. Reprod. Update. 2009; 15(4): 441-61. https://dx.doi.org/10.1093/humupd/dmp007.
- 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.https://dx.doi.org/10.1016/j.repbio.2020.100470.
Received 17.11.2022
Accepted 29.11.2022
About the Authors
Elena V. Virivskaya, PhD, leading expert, Clinic Semeynaya, elenglikman@yandex.ruKamil 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), doctorbah@mail.ru, 8-2 Trubetskaya str., Moscow, 119991, Russia.
Kristina D. Evstratova, student, Pirogov Russian National Research Medical University, Ministry of Health of Russia, 2901121@mail.ru,
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)
http://dx.doi.org/10.18565/aig.2022.272
Similar Articles
