EFFECTIVENESS OF COMBINED SURGICAL AND HORMONAL THERAPY IN TREATMENT OF ENDOMETRIOMAS.

Introduction: Endometrial cyst, or endometrioma, is a specific form of endometriosis that often reveals with severe symptoms and requires ongoing treatment. High rate of recurrence after surgical intervention presents a significant challenge in the management of this disease.

Aim Of The Study: Aim of the study was to determine the effectiveness of combined therapy (surgical and hormonal) of endometrioma in terms of development of recurrences, the rate of pregnancy and change in pain intensity.

Material And Methods: Study group consisted of 264 patients with endometrioma who underwent laparoscopic intervention with enucleation of endometrial cyst. The study group was divided into: Group I - patients who were treated with dienogest for 6 months continuously (n-58); Group II - patients treated with combined contraceptives (COC) for 6 months cyclically (n-62); Group III - patients treated with dydrogesterone for 6 months, cyclically (n-45); Group IV - control group, patients who did not undergo postoperative hormone treatment (n-99).

Results: At 5-year post-operative follow-up, the pregnancy rate was significantly higher in Gr.I (72.4% (n-21), P<0.01) compared to control (34.8% (n-8)) and Gr.III (47.2% (n-17), P<0.05). No significant difference in terms of pregnancy occurrence was found between Gr.III and the control group (P>0.05). Assessment of pregnancy rate in Gr. II was not available as none in this group desired pregnancy. In Gr. I and Gr. III recurrence of endometrial cyst did not develop in any case, in Gr. II endometrioma recurrence was observed at 1.6%, which is significantly lower compared to control group (18.2%, P<0.01). No significant difference between the groups of hormone therapy was detected (P>0.05). After the hormone therapy, severe pain was not observed in any of the patients. Pain transformed from severe to moderate in Gr.I in 59.4% , in Gr. II - in 44.5% , in Gr. III - in 76.2%, in the control group -in 93.7% of cases and no longer experienced pain in Gr.I - 40.6%, in Gr.II -in 55.5%, in Gr.III - in 23.8%, in the control group - in 6.3 % . Treatment with dienogest and COC after surgery was found to be significantly more effective compared to the results obtained with Dydrogesterone (P<0.05) or surgical treatment alone (P<0.05). In patients with moderate pain, pain of moderate intensity did not remain in any patient in Gr.I, in Gr.II it remained at 3.8%, in Gr.III- in 16% and in the control group - in 46.9% (n-39). All forms of hormone therapy were found to be significantly more effective compared to treatment with surgical intervention alone (P<0.05). No significant difference was found between the methods of hormone therapy in terms of moderate pain intensity (P>0.05).

Conclusion: After surgical treatment of endometrioma, in cases of using different hormonal medications (Dienogest, COC, Dydrogesterone), the rate of recurrence of endometrioma is significantly lower compared to surgical intervention only, and the effectiveness of different hormonal medications showed no significant difference between groups. Pregnancy rate is significantly higher in Dienogest and Dydrogesterone groups compared to only surgical intervention. In cases of severe pain, treatment with Dienogest and COC is significantly effective compared with Dydrogesterone therapy or surgery alone. In cases of moderate pain all forms of hormone therapy were found to be significantly more effective compared to surgical intervention alone.