Long-term cyclic and continuous oral contraceptive therapy and endometrioma recurrence: a randomized controlled trial.
OBJECTIVE
To evaluate long-term cyclic and continuous administration of oral contraceptive pills (OCP) in preventing ovarian endometrioma recurrence after laparoscopic cystectomy.


METHODS
Prospective, randomized, controlled trial.


METHODS
Tertiary care University Hospital.


METHODS
Two hundred thirty-nine women who underwent laparoscopic excision of ovarian endometriomas.


METHODS
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.


METHODS
Endometrioma recurrence, size of recurrent endometrioma, and growth rate during at least 2 years follow-up evaluated by transvaginal ultrasonography.


RESULTS
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.


CONCLUSIONS
Long-term cyclic and continuous postoperative use of OCP can effectively reduce and delay endometrioma recurrence.
Seracchioli
Renato
R
Minimally Invasive Gynaecological Surgery Unit, Reproductive Medicine Unit, S Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. seracchioli@aosp.bo.it
Mabrouk
Mohamed
M
Frascà
Clarissa
C
Manuzzi
Linda
L
Montanari
Giulia
G
Keramyda
Arianna
A
Venturoli
Stefano
S
D000328:Adult; D003131:Combined Modality Therapy; D003277:Contraceptives, Oral, Combined / Q000008:administration & dosage*; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage*; D003279:Contraceptives, Oral, Sequential / Q000008:administration & dosage*; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D004715:Endometriosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery; D004997:Ethinyl Estradiol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy; D009652:Norpregnenes / Q000008:administration & dosage*; D010049:Ovarian Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery; D011446:Prospective Studies; D055502:Secondary Prevention; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
D003277:Contraceptives, Oral, Combined; D003278:Contraceptives, Oral, Hormonal; D003279:Contraceptives, Oral, Sequential; D009652:Norpregnenes; C033273:Gestodene; D004997:Ethinyl Estradiol