title: Combined surgical and hormone therapy for endometriosis is the most effective treatment: prospective, randomized, controlled trial.
abstract: OBJECTIVE
  To evaluate 3 therapy strategies: hormone therapy, surgery, and combined treatment.
  
  
  METHODS
  Prospective, randomized, controlled study (Canadian Task Force classification I).
  
  
  METHODS
  University-based teaching hospital.
  
  
  METHODS
  Four hundred fifty patients with genital endometriosis, aged 18 to 44 years, before first laparoscopy.
  
  
  METHODS
  Patients were randomly assigned to 1 of 3 treatment groups: hormone therapy, surgery, or combined treatment. Patients were reevaluated at second-look laparoscopy, at 2 to 2 months after 3-month hormone therapy in groups 1 and 3 and at 5 to 6 months in group 2 (surgical treatment alone). Outcome data were focussed on the endometriosis stage, recurrence of symptoms, and pregnancy rate.
  
  
  RESULTS
  All treatment options, independent of the initial Endoscopic Endometriosis Classification stage, achieved an overall cure rate of ≥50%. A cure rate of 60% was achieved with the combined treatment, 55% with exclusively hormone therapy, and 50% with exclusively surgical treatment. Recurrence of symptoms was lowest in patients who received combined treatment. Significant benefit was achieved for dysmenorrhea and dyspareunia. An overall pregnancy rate of 55% to 65% was achieved, with no significant difference between the therapeutic options.
  
  
  CONCLUSIONS
  In the quest to find the most effective treatment of genital endometriosis, this clinical randomized study shows the lowest incidence of recurrence with combined surgical and medical treatment and improved pregnancy rate in any medically treated patients with or without surgery. The highest cure rate (Endoscopic Endometriosis Classification stage 0) for endometriosis was also achieved in the combined treatment group.
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Center Schleswig-Holstein, Kiel, Germany.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Alkatout
authors.forename: Liselotte
authors.initials: L
authors.lastname: Mettler
authors.forename: Carmen
authors.initials: C
authors.lastname: Beteta
authors.forename: Jürgen
authors.initials: J
authors.lastname: Hedderich
authors.forename: Walter
authors.initials: W
authors.lastname: Jonat
authors.forename: Thoralf
authors.initials: T
authors.lastname: Schollmeyer
authors.forename: Ali
authors.initials: A
authors.lastname: Salmassi
mesh_terms: D000293:Adolescent; D000328:Adult; D003131:Combined Modality Therapy; D004715:Endometriosis / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D005831:Genital Diseases, Female / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D010535:Laparoscopy; D016729:Leuprolide / Q000627:therapeutic use*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D005300:Fertility Agents, Female; D016729:Leuprolide
keywords: Combined treatment; Endometriosis; Hormone therapy; Infertility; Laparoscopy; Prospective studies; Recurrence; Reoperation