gestodene and Endometriosis

The primary aim of the study was to analyze the endometrioma recurrence rate in patients who underwent laparoscopic excision followed by postoperative long-term regimen of oral contraceptives (OCs).. 168 patients who underwent a conservative laparoscopic surgery for endometrioma, during the period between September 2009 and August 2010 in three university hospitals were studied. A long-term OCs therapy was offered to all women following surgery. Patients were randomly divided into three groups according to different progestins used (desogestrel, gestodene, dienogest). Women who refused a postoperative hormonal therapy served as control. Follow-up visits and transvaginal scan were planned at 1, 3, 6, 12, and 24 months after surgery. All patients who showed an ultrasound persistence of the endometrioma at 1 month follow-up were excluded from clinical analysis.. Of the 168 patients, 131 completed the 24 months follow-up. Endometrioma recurrence was found in 21 (12.5 %) of all patients, it was unilateral in 17 cases while bilateral in 4 cases. The rate of recurrent endometrioma was statistically significant in non-users compared to the long-term OCs treated patients.. The current data suggest the usefulness of long-term OCs regimen after conservative surgery for the prevention of ovarian endometrioma recurrence. As a statistical significant difference could not be observed between OCs groups, further study on the individual molecules is required in order to really understand the effect of each of them.

Topics: Adolescent; Adult; Combined Modality Therapy; Contraceptives, Oral; Desogestrel; Drug Administration Schedule; Endometriosis; Female; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Laparoscopy; Nandrolone; Norpregnenes; Ovarian Diseases; Secondary Prevention; Treatment Outcome; Young Adult

To evaluate the efficacy and tolerability of postoperative depot medroxyprogesterone acetate (DMPA) versus postoperative continuous oral contraceptive (OC) pills in the treatment of endometriosis-associated pain.. After a conservative surgery, 84 patients with symptomatic endometriosis were randomized to receive either intramuscular DMPA (150 mg) every 12 weeks for 24 weeks or continuous OC pills (ethinyl estradiol 0.03 mg and gestodene 0.075 mg) daily for 24 weeks. At weeks 12 and 24 of the treatment phase, patients rated their satisfaction with treatment and reported pain improvement and adverse effects.. There was no significant difference in the percentages of patients who reported satisfaction between the DMPA group and the OC group at weeks 12 and 24 (92.9 vs. 90.5%, and 92.9 vs. 88.1%, respectively). The rates of withdrawal because of persistent pain or side effects in the two groups were similar. Pain scores improved significantly in both groups, but dysmenorrhea scores on a visual analog scale at week 24 were significantly higher in the OC group than in the DMPA group (p = 0.039).. Both postoperative DMPA and postoperative OC pills for 24 weeks were found to be effective and acceptable options for treating endometriosis-associated pain.

Topics: Adult; Analgesia; Contraceptives, Oral; Delayed-Action Preparations; Endometriosis; Ethinyl Estradiol; Female; Humans; Injections, Intramuscular; Medroxyprogesterone Acetate; Norpregnenes; Pain Measurement; Postoperative Care; Treatment Outcome

To evaluate long-term cyclic and continuous administration of oral contraceptive pills (OCP) in preventing ovarian endometrioma recurrence after laparoscopic cystectomy.. Prospective, randomized, controlled trial.. Tertiary care University Hospital.. Two hundred thirty-nine women who underwent laparoscopic excision of ovarian endometriomas.. Patients were divided randomly into three groups: nonusers receiving no therapy and cyclic and continuous users receiving low-dose, monophasic OCP for 24 months in cyclic or continuous administration, respectively.. Endometrioma recurrence, size of recurrent endometrioma, and growth rate during at least 2 years follow-up evaluated by transvaginal ultrasonography.. The crude recurrence rate within 24 months was significantly lower in cyclic (14.7%) and continuous users (8.2%) compared with nonusers (29%). The recurrence-free survival was significantly lower in nonusers compared with cyclic and continuous users. The mean recurrent endometrioma diameter at first observation was significantly lower in cyclic (2.17 +/- 0.45 cm) and continuous users (1.71 +/- 0.19 cm) compared with nonusers (2.73 +/- 0.56 cm). The mean diameter increase every 6 months of follow-up was significantly reduced in cyclic users (0.31 +/- 0.18 cm) and continuous users (0.25 +/- 0.09 cm) versus nonusers (0.48 +/- 0.3 cm). No significant differences between cyclic users and continuous users in terms of endometrioma recurrence were demonstrated.. Long-term cyclic and continuous postoperative use of OCP can effectively reduce and delay endometrioma recurrence.

Topics: Adult; Combined Modality Therapy; Contraceptives, Oral, Combined; Contraceptives, Oral, Hormonal; Contraceptives, Oral, Sequential; Disease-Free Survival; Drug Administration Schedule; Endometriosis; Ethinyl Estradiol; Female; Humans; Kaplan-Meier Estimate; Laparoscopy; Norpregnenes; Ovarian Diseases; Prospective Studies; Secondary Prevention; Severity of Illness Index; Time Factors; Treatment Outcome; Ultrasonography

To assess the recurrence rate of endometrioma after laparoscopic cystectomy plus hormonal suppression treatment or plus dietary therapy compared to post-operative placebo.. A randomized comparative trial was conducted on 259 consecutive women who underwent laparoscopic unilateral/bilateral cystectomy for endometrioma. Seven days after surgery, the patients were randomly allocated on the basis of a computer-generated randomization sequence, to one of four post-operative management arms as follows: placebo (n=65) or gonadotrophin-releasing hormone analogue (tryptorelin or leuprorelin, 3.75 mg every 28 days) (n=65) or continuous low-dose monophasic oral contraceptives (ethynilestradiol, 0.03 mg plus gestoden, 0.75 mg) (n=64) or dietary therapy (vitamins, minerals salts, lactic ferments, fish oil) (n=65) for 6 months. At 18 months' follow-up after surgery, all patients were monitored with a clinical gynecologic examination, and a transvaginal ultrasonography for possible evidence of endometrioma recurrence.. At 18 months' transvaginal ultrasonographic follow-up after surgery, no significant recurrence rate of endometrioma was detected in women who received a postoperative course of hormonal suppression treatment or dietary therapy when compared with placebo (placebo vs. GnRH-a P=0.316, placebo vs. estroprogestin P=0.803, placebo vs. dietary therapy P=0.544). Second-look laparoscopy was performed on a clinical basis and confirmed the ultrasonographic suspicion of recurrence of endometrioma in all cases: 10 (16.6%) in the post-operative placebo group vs. 6 (10.3%) in the post-operative GnRH-a group vs. 9 (15.0%) in the post-operative continuous estroprogestin group vs. 11 (17.8%) in the post-operative dietary therapy group. Of 36 patients with recurrent ovarian endometriosis, 8 had recurrence on the treated ovary, 20 on the contralateral ovary that appeared to be normal at the time of the first-line surgery, and 8 on both the treated and untreated ovaries. Endometrioma recurrences were associated with moderate-to-severe painful symptoms in 14/36 patients (38.8%), while the remaining 22 (61.1%) patients were asymptomatic.. A 6-month course of hormonal suppression treatment or dietary therapy after laparoscopic cystectomy had no significant effect on the recurrence rate of ovarian endometriosis when compared with surgery plus placebo. So, treatment of endometrioma can be carried out exclusively by laparoscopic cystectomy without post-operative therapy, if a complete excision of ovarian endometriosis has been assured.

Topics: Adult; Combined Modality Therapy; Contraceptives, Oral, Combined; Diet Therapy; Dietary Supplements; Endometriosis; Endometrium; Ethinyl Estradiol; Female; Follow-Up Studies; Gonadotropin-Releasing Hormone; Gynecologic Surgical Procedures; Humans; Laparoscopy; Leuprolide; Minerals; Norpregnenes; Secondary Prevention; Treatment Outcome; Ultrasonography; Uterine Diseases; Vitamins

Limited attention has been focused on the medical treatment of bowel endometriosis. This study evaluates the efficacy of administration of a continuous low-dose oral contraceptive in treating pain and other symptoms associated with colorectal endometriotic nodules, as evaluated by rectal endoscopic ultrasonography.. Prospective observational study.. Academic Department of San Raffaele Scientific Institute, Obstetrics and Gynecology Unit.. Symptomatic women of reproductive age (n=26) with colorectal nodules infiltrating at least the bowel muscularis propria and without a stenosis >50%. In 31% of the patients, endoscopic ultrasonography permitted diagnosis of nodules located more than 10 cm from the anal rim.. Patients received a continuous low-dose oral contraceptive containing 15 μg ethinylestradiol and 60 μg gestodene for 12 months. Subjective symptoms were prospectively evaluated, and nodule volumes were monitored using endoscopic ultrasonography.. Nodule measurements were performed at baseline and after 12 months of treatment. Symptoms at the start and after 12 months were evaluated.. A significant improvement in the intensity of all the considered symptoms (dysmenorrhea, non-menstrual pelvic pain, deep dyspareunia and painful defecation) was seen when evaluated by a visual analog scale. A reduction in terms of both diameter (mean reduction 26%) and volume of the nodules (mean reduction 62%) was observed after a 12 month period.. A continuous low-dose oral contraceptive therapy may reduce bowel endometriosis-associated symptoms. In addition, this therapy induces a significant volumetric reduction of colorectal plaques when evaluated by endoscopic ultrasonography.

Topics: Adult; Colonic Diseases; Contraceptives, Oral, Synthetic; Dose-Response Relationship, Drug; Drug Combinations; Dysmenorrhea; Dyspareunia; Endometriosis; Endosonography; Ethinyl Estradiol; Female; Humans; Norpregnenes; Pain Measurement; Pelvic Pain; Prospective Studies; Rectal Diseases

To report a case of endometriosis located at an unusual site in the canal of Nuck.. Case report.. Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital.. A 35-year-old woman with no previous history of surgery had endometriosis in the canal of Nuck excised incompletely via an open skin method. Recurrent endometriosis at the canal of Nuck was noted 9 months later despite postoperative medical treatment.. Laparoscopic surgery and open skin method.. Removal of endometriosis in the canal of Nuck and repair of the inguinal ring.. The patent left canal of Nuck identified, endometriosis completely resected, and the inguinal ring closed. She was well 12 months after the second surgery.. We suggest that when encountering endometriosis in the canal of Nuck, removing all involved lesions and closing of the internal inguinal ring is indicated.

Topics: Adult; Contraceptives, Oral, Combined; Danazol; Drug Therapy, Combination; Endometriosis; Ethinyl Estradiol; Female; Humans; Inguinal Canal; Laparoscopy; Norpregnenes; Recurrence; Reoperation; Treatment Outcome

To determine the effect of oral contraceptives containing gestodene on aromatase expression in the endometrium of patients diagnosed with endometriosis.. Endometrial biopsies were taken at the time of laparoscopy in 40 patients with endometriosis, 16 of whom were using an oral contraceptive containing gestodene at the time of laparoscopy. The remaining 24 patients were receiving no form of treatment for endometriosis. Endometrial biopsies taken from 23 patients with normal echographic signs and no symptoms were used as controls. Aromatase expression was evaluated in endometrial samples using immunohistochemistry.. In the untreated, symptomatic endometriosis patients, aromatase expression was detected during the proliferative phase in 92% of cases, while in the symptom-free control patients aromatase was expressed in only 9% of cases. In patients with endometriosis who were using oral contraceptives, there were significantly fewer cases of positive endometria compared with the untreated patients with endometriosis (6%).. Oral contraceptives containing gestodene are effective in decreasing aromatase expression in the eutopic endometrium of patients with endometriosis.

Topics: Adult; Aromatase; Contraceptives, Oral; Contraceptives, Oral, Synthetic; Endometriosis; Endometrium; Female; Follicular Phase; Humans; Immunohistochemistry; Norpregnenes; Retrospective Studies