Post-operative GnRH analogue treatment after conservative surgery for symptomatic endometriosis stage III-IV: a randomized controlled trial.
BACKGROUND
In order to decrease endometriosis recurrence after surgical therapy, it has been proposed to use a post-surgical oestrogen-lowering medical treatment. Results from previous trials on this topic are contradictory.


METHODS
A total of 89 women were randomized, by computer-generated list, after laparoscopic conservative surgery for symptomatic endometriosis stage III-IV to receive monthly i.m. injections of gonadotrophin-releasing hormone (GnRH) analogue, leuprolide acetate depot (3.75 mg) for 3 months (n = 44) or to an expectant management (n = 45). All patients were followed up every 6 months for evaluation of pain symptoms, fertility and objective disease recurrence.


RESULTS
During the follow-up, which ranged from 6-36 months, five (33%) of the 15 women who wanted children and who were allocated the GnRH analogue and six (40%) of the 15 given no treatment became pregnant (not significant). Moderate/severe pelvic pain recurred during the follow-up in 10 (23%) of the women allocated the GnRH analogue and 11 (24%) of those allocated no treatment; the cumulative pain recurrence rates at 18 months were 23 and 29% respectively (not significant). Four women (9%) treated with GnRH analogue and four women (9%) who received no treatment had objective disease recurrence as demonstrated by gynaecological examination and/or pelvic ultrasonography.


CONCLUSIONS
This study does not support the routine post-operative use of a 3 month course of GnRH analogue in women with symptomatic endometriosis stage III-IV.
Busacca
M
M
II Department of Obstetrics and Gynecology, University of Milano, Milan, Italy. auro.busacca@unimi.it
Somigliana
E
E
Bianchi
S
S
De Marinis
S
S
Calia
C
C
Candiani
M
M
Vignali
M
M
D000328:Adult; D003692:Delayed-Action Preparations; D004412:Dysmenorrhea / Q000628:therapy; D004414:Dyspareunia / Q000628:therapy; D004715:Endometriosis / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D016729:Leuprolide / Q000009:adverse effects / Q000627:therapeutic use*; D017699:Pelvic Pain; D011182:Postoperative Care; D011247:Pregnancy; D012008:Recurrence; D012086:Reoperation
D003692:Delayed-Action Preparations; D016729:Leuprolide