The effect of combined surgical-medical intervention on the progression of endometriosis in an adolescent and young adult population.
OBJECTIVE
To evaluate the effect of combined surgical-medical treatment on endometriosis progression in adolescents as measured by disease stage.


METHODS
Retrospective chart review.


METHODS
Two academic medical centers.


METHODS
Sequential cases of young women identified on chart review with chronic pelvic pain unresponsive to dysmenorrheal treatment who underwent initial laparoscopy for diagnosis and surgical destruction of endometriosis. All patients were then treated with standard continuous medical therapy. Patients with exacerbation of pain on anti-endometriosis medical therapy who elected a subsequent laparoscopic procedure were eligible for this study.


METHODS
Retrospective chart review


METHODS
Endometriosis stage and adhesions at subsequent laparoscopy as compared to the initial surgical procedure.


RESULTS
90 patients met inclusion criteria. Eligible patients were 12 to 24 years of age at the time of the initial laparoscopy. The median endometriosis stage at first and second laparoscopy was I. No stage change was observed in 70% of patients, 19% improved by one stage, 1% improved by two stages, and 10% worsened by one stage. Regardless of initial stage, a trend toward disease progression was not observed. There was a significant likelihood for stage improvement at second laparoscopy, with those initially diagnosed as stage II or III most likely to exhibit improvement.


CONCLUSIONS
Based on the concept that endometriosis can be progressive, these data suggest that combined surgical-medical management retards disease progression in adolescents and young adults.
Doyle
J O
JO
Division of Gynecology, Children's Hospital Boston, Boston, Massachusetts, USA.
Missmer
S A
SA
Laufer
M R
MR
D000293:Adolescent; D002648:Child; D003131:Combined Modality Therapy; D003277:Contraceptives, Oral, Combined / Q000627:therapeutic use; D018450:Disease Progression; D004564:Electrocoagulation; D004715:Endometriosis / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use; D006801:Humans; D010535:Laparoscopy; D054020:Lasers, Gas / Q000627:therapeutic use; D016729:Leuprolide / Q000627:therapeutic use; D017258:Medroxyprogesterone Acetate / Q000627:therapeutic use; D010532:Peritoneal Diseases / Q000188:drug therapy* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D003277:Contraceptives, Oral, Combined; D005300:Fertility Agents, Female; D017258:Medroxyprogesterone Acetate; D016729:Leuprolide