title: Postoperative medical therapy after surgical treatment of endometriosis: from adjuvant therapy to tertiary prevention.
abstract: The high rate of disease recurrence after surgery is critical and frustrating for women with endometriosis. Adjuvant treatments using a 3- to 6-months course of hormone therapy after surgery have been extensively investigated during the last 2 decades; however, results have been unsatisfactory, primarily because the benefits of hormone therapy rapidly vanish once treatment is discontinued. The protective effect is limited to the period of use. Accordingly, it is recognized that suppressive hormone therapy after surgery markedly prevents recurrent episodes only if given over the long term. The emerging view is that estroprogestins do not ameliorate the effects of surgery but demonstrate tertiary prevention of the disease. They prevent ovulation and reduce retrograde menstrual flow, two crucial events in the pathogenesis of endometriosis. The available literature strongly supports the benefits of prolonged administration of estroprogestins after surgery in preventing recurrence of endometriomas and dysmenorrhea. In contrast, data on dyspareunia and nonmenstrual pelvic pain remain scanty and unconvincing, and there is no information about recurrence of other forms of endometriosis such as peritoneal implants and adhesions. Overall, estroprogestin therapy after surgery to treat endometriosis should be recommended in women who do not seek to become pregnant. Further evidence is warranted to better delineate the beneficial effects of this emerging but convincing strategy.
authors.affiliation: Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy. Electronic address: dadosomigliana@yahoo.it.
authors.forename: Edgardo
authors.initials: E
authors.lastname: Somigliana
authors.affiliation: Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Università degli Studi di Milano, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Vercellini
authors.affiliation: Obstetrics and Gynecology Unit, Scientific Institute San Raffaele, Milan, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Vigano
authors.affiliation: Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Benaglia
authors.affiliation: Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Università degli Studi di Milano, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Busnelli
authors.affiliation: Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Università degli Studi di Milano, Milan, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Fedele
mesh_terms: D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D004338:Drug Combinations; D004412:Dysmenorrhea / Q000209:etiology / Q000517:prevention & control; D004414:Dyspareunia; D004715:Endometriosis / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D004997:Ethinyl Estradiol / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D009652:Norpregnenes / Q000627:therapeutic use*; D017699:Pelvic Pain / Q000209:etiology; D011184:Postoperative Period; D012008:Recurrence; D055512:Tertiary Prevention; D000267:Tissue Adhesions
chemical_list: D004338:Drug Combinations; D009652:Norpregnenes; C494367:estroprogestin; D004997:Ethinyl Estradiol
keywords: Endometriosis; Estroprogestin; Recurrence