Impact of Laparoscopic Excision of Ovarian Endometrioma on Menstrual Pattern

Abstract

Study Objective: Endometrioma is one of the most frequent pathologies in gynecologic surgery. Laparoscopic cyst excision is considered the best treatment option in terms of lower recurrence and improved fertility. However, it has been questioned whether the excision of the endometrioma could impair the function of the affected ovary and if it could decrease the future fertility. The aim of this study was to verify the impact of laparoscopic excision of endometrioma on ovarian function in term of menstrual pattern.Design: Retrospective analysis of 289 women in childbearing age operated on for uni- or bilateral endometriomas.Setting: University Hospital.Patients: Two hundred and eighty-nine patients (ages 20–42 yrs) were contacted by phone and interviewed.Intervention: Laparoscopic excision of ovarian endometrioma.Measurements and Main Results: One hundred and fifty-two patients (53%) answered the questionnaire. Seventy-five patients had a unilateral cyst (20 right; 55 left) while other 77 had bilateral. After the surgery 119/152 patients referred normal menstruation, while abnormalities were reported in 21.7% (polymenorrhea 12%; oligomenorrhea 9.2%; amenorrhea 1.97%). Polymenorrhea was statistically more frequent in patients with bilateral endometrioma than those with unilateral. Three patients, 44, 37 and 42 years old, normally menstruated before surgery, experienced ovarian failure 1, 17 and 57 months respectively after operation. All these three women had bilateral ovarian deep endometriosis.Conclusion: Although all affected women reported regular menstrual cycle before the intervention, almost one quarter referred post-surgical menstrual abnormalities. Despite the entity of the hypothetical injury related to the presence of the cyst, it is likely that surgery may also damage ovarian reserve by means of electrosurgical coagulation during hemostasis. This risk should be discussed with patients undergoing surgery, particularly those patients who are going to be operated on for bilateral endometriomas. Study Objective: Endometrioma is one of the most frequent pathologies in gynecologic surgery. Laparoscopic cyst excision is considered the best treatment option in terms of lower recurrence and improved fertility. However, it has been questioned whether the excision of the endometrioma could impair the function of the affected ovary and if it could decrease the future fertility. The aim of this study was to verify the impact of laparoscopic excision of endometrioma on ovarian function in term of menstrual pattern. Design: Retrospective analysis of 289 women in childbearing age operated on for uni- or bilateral endometriomas. Setting: University Hospital. Patients: Two hundred and eighty-nine patients (ages 20–42 yrs) were contacted by phone and interviewed. Intervention: Laparoscopic excision of ovarian endometrioma. Measurements and Main Results: One hundred and fifty-two patients (53%) answered the questionnaire. Seventy-five patients had a unilateral cyst (20 right; 55 left) while other 77 had bilateral. After the surgery 119/152 patients referred normal menstruation, while abnormalities were reported in 21.7% (polymenorrhea 12%; oligomenorrhea 9.2%; amenorrhea 1.97%). Polymenorrhea was statistically more frequent in patients with bilateral endometrioma than those with unilateral. Three patients, 44, 37 and 42 years old, normally menstruated before surgery, experienced ovarian failure 1, 17 and 57 months respectively after operation. All these three women had bilateral ovarian deep endometriosis. Conclusion: Although all affected women reported regular menstrual cycle before the intervention, almost one quarter referred post-surgical menstrual abnormalities. Despite the entity of the hypothetical injury related to the presence of the cyst, it is likely that surgery may also damage ovarian reserve by means of electrosurgical coagulation during hemostasis. This risk should be discussed with patients undergoing surgery, particularly those patients who are going to be operated on for bilateral endometriomas.