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Recurrence of endometrioma after laparoscopic excision and its prevention by medical management

Kaori Koga1,*,Yutaka Osuga1,Yuri Takemura1,Masashi Takamura1,Yuji Taketani1
1
Department of Obstetrics and Gynecology, School of Medicine, University of Tokyo, Japan, 7-3-1 Hongo Bunkyo Tokyo, 113- 8655, Japan
DOI: 10.2741/E648 Volume 5 Issue 2, pp.676-683
Published: 01 January 2013
(This article belongs to the Special Issue Frontiers in endometriosis)
*Corresponding Author(s):  
Kaori Koga
E-mail:  
kawotan-tky@umin.ac.jp
Abstract

Laparoscopic excision is considered as the ‘gold standard’ treatment of ovarian endometrioma. However, a frustrating aspect is that disease can recur. While laparoscopic excision is known to improve fertility, recurrence can cause significant ovarian damage and adverse affects on fertility. It is therefore crucial to prevent recurrence in order to conserve ‘improved’ fertility. Recurrence rates for endometrioma are reported from 11 to 32% within 1-5 years after excision. The recurrence rate is higher in patients with advanced endometriosis at surgery and in younger patients. Previous medical treatment for endometriosis prior laparoscopy is a risk factor for recurrence. Pregnancy soon after surgery has a protective effect for recurrence. The accumulating evidence suggests that the administration of oral contraceptives (OC), levonorgestrel-releasing intrauterine system (LNG-IUS) and a combination of gonadotropin releasing hormone (GnRH) analogue and OC may also have therapeutic benefits. Collectively, we propose that women should be well informed about the risks of endometrioma recurrence. We recommend that women who wish pregnancy should try conception as soon as possible. Further, we strongly advise hormonal therapy for patients, who do not want to conceive immediately, and until pregnancy is desired.

Key words

Endometriosis, Laparoscopy, Recurrence, Oral Contraceptives, Review

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Kaori Koga, Yutaka Osuga, Yuri Takemura, Masashi Takamura, Yuji Taketani. Recurrence of endometrioma after laparoscopic excision and its prevention by medical management. Frontiers in Bioscience-Elite. 2013. 5(2); 676-683.