Qian Zhu1,2,3, Jue Ma1,2,3, Xiaoya Zhao1,2,3, Guiling Liang1,2,3, Jing Zhai4, Jian Zhang1,2,3. 1. Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. 2. Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China. 3. Shanghai Municipal Key Clinical Specialty, Shanghai, China. 4. School of Public Health, Shanghai Jiao Tong University, Shanghai, China.
Abstract
OBJECTIVE: To compare the efficacy of postoperative adjuvant treatment (gonadotropin-releasing hormone agonists [GnRHas] and oral contraceptives [OCs]) and expectant treatment in preventing recurrent dysmenorrhea following conservative laparoscopic surgery for deep infiltrating endometriosis (DIE) with dysmenorrhea. METHODS: A prospective cohort study was conducted in Shanghai, China. In total, 147 patients with dysmenorrhea who underwent conservative laparoscopic surgery for DIE were enrolled. Following surgery, patients received either postoperative adjuvant therapy (GnRHa or OCs) for 6 months or expectant treatment according to a shared medical decision-making approach. The primary outcome was the postoperative recurrence of dysmenorrhea. The secondary outcomes included reproductive outcomes and drug-induced side effects. RESULTS: The generalized estimating equation analysis illustrated that the visual analog scale for dysmenorrhea was significantly higher in the adjuvant treatment group than in the expectant treatment group. Kaplan-Meier analysis and the log-rank test demonstrated that the cumulative recurrence rate was higher in the expectant treatment group than in the adjuvant treatment group, but no difference was noted between the two hormonal treatments. Similar cumulative 24-month clinical pregnancy rates were observed among the three groups. CONCLUSIONS: Compared with expectant management, postoperative medical treatment more effectively relieved symptoms and prevented the recurrence of dysmenorrhea.
OBJECTIVE: To compare the efficacy of postoperative adjuvant treatment (gonadotropin-releasing hormone agonists [GnRHas] and oral contraceptives [OCs]) and expectant treatment in preventing recurrent dysmenorrhea following conservative laparoscopic surgery for deep infiltrating endometriosis (DIE) with dysmenorrhea. METHODS: A prospective cohort study was conducted in Shanghai, China. In total, 147 patients with dysmenorrhea who underwent conservative laparoscopic surgery for DIE were enrolled. Following surgery, patients received either postoperative adjuvant therapy (GnRHa or OCs) for 6 months or expectant treatment according to a shared medical decision-making approach. The primary outcome was the postoperative recurrence of dysmenorrhea. The secondary outcomes included reproductive outcomes and drug-induced side effects. RESULTS: The generalized estimating equation analysis illustrated that the visual analog scale for dysmenorrhea was significantly higher in the adjuvant treatment group than in the expectant treatment group. Kaplan-Meier analysis and the log-rank test demonstrated that the cumulative recurrence rate was higher in the expectant treatment group than in the adjuvant treatment group, but no difference was noted between the two hormonal treatments. Similar cumulative 24-month clinical pregnancy rates were observed among the three groups. CONCLUSIONS: Compared with expectant management, postoperative medical treatment more effectively relieved symptoms and prevented the recurrence of dysmenorrhea.
Authors: Paolo Vercellini; Giuliana Pietropaolo; Olga De Giorgi; Raffaella Daguati; Roberta Pasin; Pier Giorgio Crosignani Journal: Am J Obstet Gynecol Date: 2006-05-16 Impact factor: 8.661
Authors: G A J Dunselman; N Vermeulen; C Becker; C Calhaz-Jorge; T D'Hooghe; B De Bie; O Heikinheimo; A W Horne; L Kiesel; A Nap; A Prentice; E Saridogan; D Soriano; W Nelen Journal: Hum Reprod Date: 2014-01-15 Impact factor: 6.918