Hormonal treatments for preventing recurrence of endometriomas

Endometriosis is a chronic condition determined by the presence of ectopic endometrial glands and stroma. The disease affects approximately 10% of women of reproductive age and 35-50% of women with chronic pelvic pain and/or infertility. Transvaginal ultrasonography is a very sensitive and specific instrument for the diagnosis of endometrioma. Surgical and/or medical therapies for endometriomas aim to control symptoms (in particular, chronic pelvic pain and dysmenorrhea) and prevent cyst growth; medical therapy may be employed to reduce recurrence rate after surgery. After surgical approach, the reported postoperative recurrence rate of endometriomas is high, ranging from 30% to 40%; therefore, several hormonal therapies, such as oral contraceptives (OC), progestins (PG), GnRH analogs (GnRHa), and antagonists, danazol, aromatase inhibitors, selective estrogen receptor modulators (SERMs) and selective progesterone receptor modulators (SPRMs), have been employed in order to prevent disease recurrence. The objective of this systematic review is to assess the impact of the adjuvant use of hormonal treatment on endometrioma recurrence. Two evaluators extracted from MEDLINE, EMBASE, and Cochrane Library and reviewed published studies on this topic, following pre-determined selection criteria. Finally, data were extracted from 16 selected prospective or retrospective studies, of which 8 were randomized controlled trial and 8 were cohort studies. Most of them reported a beneficial impact on endometrioma recurrence by the usage of OC, PG, and GnRH analogs (GnRHa); however, conflicting results exist in the current literature about this topic. The duration of adjuvant therapy seems to have a crucial role in this context, but it is still not clear which type of postoperative hormonal treatment represents the best choice.