goserelin and Ovarian-Cysts

To evaluate the role of GnRH agonist (GnRH-a) and/or drainage in the management of large endometriomas.. This prospective clinical study was conducted in a parallel and randomized design.. Department of Gynecology, Cliniques Universitaires St. Luc, Brussels, Belgium.. Eight infertile women with laparoscopically confirmed ovarian endometriotic cysts. After laparoscopic drainage of the ovarian cyst, patients were randomized. Patients in group I (n = 40) received no therapy. Patients in group II (n = 40) received GnRH-a therapy for 12 weeks. A second-look laparoscopy was performed after 12 weeks in each woman.. After drainage, a quick recurrence of the endometrial cyst was observed in only group I. Indeed, the score and the cyst size were similar to the values observed before the first laparoscopy. In group II, a significant decrease in score and cyst diameter was observed. Ovarian biopsies revealed significant reduction in the stromal vascularization and a significant reduction in the mitotic activity in the group of women treated with GnRH-a.. The quick recurrence of the ovarian cyst after drainage proved that drainage alone is ineffective. Drainage followed by GnRH-a was effective in the reduction of cyst size and the glandular mitotic activity.

Topics: Adult; Biopsy; Drainage; Endometriosis; Female; Goserelin; Humans; Laparoscopy; Ovarian Cysts; Ovarian Diseases; Ovary; Prospective Studies

Uterine myomas and endometriosis are benign pathologies frequently encountered in women. Myomas are often associated with infertility and/or menorrhagia particularly if they are sub-mucosal. Endometriosis is diagnosed in more than 35% of infertile patients. These two common pathologies are oestrogen-dependent and the administration of a GnRH agonist has been proposed as a non-surgical approach to the treatment of myomas and endometriosis. GnRH agonists cannot, however, be considered as definitive medical therapy because most myomas and endometriotic cysts return to their initial size within 4 months following the cessation of treatment. Moreover, because of the menopausal-like state that they induce, GnRH agonists provoke bone demineralization and for this reason, their long-term use is not recommended. These agents should, therefore, be considered as an adjuvant preoperative therapy. The aim is, above all, to achieve a preoperative reduction of tumour size, thus facilitating the endoscopic surgery: either hysteroscopic resection in the case of sub-mucosal myomas, or vaporization of ovarian cysts in the case of cystic endometriotic lesions.

Topics: Adult; Biopsy; Combined Modality Therapy; Endometriosis; Female; Goserelin; Humans; Hysteroscopy; Infertility, Female; Laparoscopy; Leiomyoma; Menorrhagia; Ovarian Cysts; Preoperative Care; Prospective Studies; Treatment Outcome; Uterine Neoplasms

To evaluate follicle loss and its associated factors during laparoscopic cystectomy for ovarian endometrioma.. Between October 2008 and December 2009, 140 patients with ovarian cysts undergoing laparoscopic cystectomy at Peking Union Medical Hospital were enrolled: 74 had ovarian endometrioma with no preoperative hormonal therapy (group A), 40 had ovarian endometrioma pretreated with GnRHa (group B), and 26 had non-endometriotic cysts (group C). Pre-, peri- , and postoperative clinical data were collected, and cyst specimens were evaluated histologically.. The number of capsules showing follicles and the mean number of follicles per capsule were lower in group C than in group A or B (P<0.05). Fewer type IIC than type IIB endometriomas showed follicles (P<0.05). The number of follicles per cyst was related negatively to disease duration but positively to pain severity. Women in group A with unilateral endometrioma had a lower mean dysmenorrhea score after the surgery (P<0.05), but no change in basal follicle-stimulating hormone (FSH).. The type of cyst, disease duration, and severity of dysmenorrhea were associated with ovarian follicle loss during laparoscopic excision of endometrioma. Laparoscopic unilateral cystectomy for endometrioma was effective in relieving pain but had little effect on serum FSH, which might reflect the remaining ovarian reserve.

Topics: Adolescent; Adult; China; Dysmenorrhea; Endometriosis; Female; Follicle Stimulating Hormone; Follow-Up Studies; Goserelin; Humans; Laparoscopy; Middle Aged; Ovarian Cysts; Ovarian Follicle; Pain; Retrospective Studies; Severity of Illness Index; Time Factors; Young Adult

Topics: Female; Gonadotropin-Releasing Hormone; Goserelin; Humans; Middle Aged; Ovarian Cysts; Postmenopause

The management of large endometriomas was described in a series of 814 patients. Combined therapy using gonadotrophin-releasing hormone agonist (GnRHa) and carbon dioxide laser laparoscopy was proposed. Drainage and GnRHa for 12 weeks provoked a reduction of the endometrioma size up to 50% of the initial value. After vaporization of the internal wall, a cumulative pregnancy of 51% after 1 year was achieved. A recurrence rate of 8% was observed for a follow-up of 2-11 years. Histological data demonstrated that the epithelium covering the ovary which is the mesothelium can invaginate in the ovarian cortex. Some of the invaginations were seen to be continuous with endometrial tissue, strongly suggesting the metaplasia theory in the pathogenesis of ovarian endometrioma.

Topics: Combined Modality Therapy; Endometriosis; Female; Gonadotropin-Releasing Hormone; Goserelin; Humans; Infertility, Female; Laser Therapy; Metaplasia; Ovarian Cysts; Ovarian Diseases; Pregnancy; Recurrence