OVARIAN ENDOMETRIOSIS: RISK FACTORS OF THE PROCESS PROGRESSION AND RECURRENCE

Abstract

Ovarian endometriosis is one of the dominant forms in the structure of the external genital endometriosis and affects up to 55% of reproductive age women being one of the main causes of infertility.
 The aim of the study was to identify prognostic factors and reduce the development and recurrence of ovarian endometriosis among women of reproductive age by elaboration of the program of preventive measures.
 Materials and methods. The outpatient, in-patient, and questionnaire cards of 440 women were retrospectively analyzed. The first group included 167 patients with first time diagnosed ovarian endometrioid cysts (ОЕC), and the second group included 213 women with the recurrent ОЕC. The control group was formed of 60 healthy women without gynecologic pathology, who have given birth at least twice, and went to the clinic for a preventive examination or surgical sterilization.
 Results. The risk of OEC recurrence is higher in the women of older age group (OR=1,99; 95% СІ: (1,31-3,01); р<0,05). The size of the cysts ≤ 4 cm increases the odds of recurrence of ovarian endometriosis (OR=3.53; 95% СІ: (2.37-5.26); р<0.05) by three times; their prevalence in seven times (OR=7,01; 95% СІ: (4.35-11.30); р<0.05), combined with the pelvic inflammatory diseases – more than four times (OR=4.76; 95% СІ: (2.91-7.79); р<0.05). The combination of OEC with the endometrioid heterotopias sixteen times increases the odds of OEC recurrence (OR=16.44; 95% СІ: (9.88-27.34); р<0.05). Furthermore, a major impact on OEC recurrence has the hyperproliferative processes of the uterus and endometrium (OR=5,06; 95% СІ: (2,85-8,99); р<0,05), the menstrual disorders – algodysmenorrhea and hyperpolymenorrhea (OR=6,93; 95 % СІ (4,39-10,93); р<0,005), and the lack of anti-recurrence treatment (OR=7,24; 95% СІ: (1,99-26,34), р<0,002). Analysis of CA-125 the level before the surgical treatment showed an increase in 57.8% (108) cases, but 6 months after suppressive hormone therapy optimized with a complex of antibacterial and anti-edematous and anti-inflammatory medications, this indicator showed a statistically significant decrease in the reference limits in two-thirds of observations. The ovarian reserve before the surgical treatment was determined in 47 (25.1%) cases, a decrease in the level of Anti-Müllerian hormone is noted in one-third of observations. The rate of a below-average level after the surgical treatment increased up to 55.6% of patients, especially in the case of a combination of OEC and chronic pelvic inflammatory diseases and small forms of genital endometriosis. Our results indicate that the number of patients with low ovarian reserve or premature ovarian insufficiency increased 1.7 times compared to the data before surgical treatment. The highest percent of recurrence was noticed in cases where after the surgical treatment the anti-recurrence therapy has not been administered – 38.9 %.
 Conclusions. Canceling hormonal therapy leads to the recurrence of endometriosis regardless of the type of treatment, which requires searching for the new methods of the prolonged treatment program until the decision on pregnancy planning is made. The longest remission was noted in the case of dydrogesterone use, as well as the greatest number of spontaneous pregnancies. There is an advantage of an optimized anti-inflammation program with gestagens during the postsurgical period for the women planning for pregnancy. The recurrence of endometriomas is clearly associated with dienogest use.