Prevention of endometriosis recurrence after surgical treatment

Abstract

Introduction. The relevance of studying the mechanisms underlying the development of adenomyosis is determined not only by its high prevalence reaching 40% among reproductive aged women, but also by its association with unexplained infertility (60%), as well as woman’s quality of life impairment.Aim. To enhance efficiency of therapy after surgical treatment of endometriosis and minimize the risk of disease recurrence.Materials and methods. In a cohort prospective comparative study conducted on the basis of the gynecological department of the Inozemtsev City Clinical Hospital, 80 patients of reproductive age who underwent organ-preserving treatment for external genital endometriosis and nodular adenomyosis were included. Dienogest (Zafrilla) was prescribed to 65 patients at a dose of 2 mg/day (1 tablet) from day 2 after surgical treatment continuously for 6 months, taking into account contraindications to its use, 15 patients refused to take the drug in the postoperative period, and made up the control group.Results. The results of the study showed that after surgical treatment of external genital endometriosis and the nodular form of adenomyosis and the appointment of suppressive therapy with Zafrilla, after 3 months, the intensity of the pain syndrome was transformed according to the VAS, NRS, B&B scales by one step, and after 6 months it decreased to a slight (p < 0.05), which contributed to the improvement of the quality of life of patients based on the EHP-30 questionnaire. The long-term results of the study allow us to recommend the drug Zafrilla, with high compliance, good tolerance, a favorable safety profile, in order to reduce pain, the intensity of menstrual flow, and prevent recurrence of the disease based on 24 months of observation.Conclusion. An integrated approach to the treatment of external genital endometriosis and nodular adenomyosis, including surgical treatment and suppressive therapy with Zafrilla, made it possible to realize reproductive function in 48% of patients. Taking dienogest for 24 weeks provided effective relief of pain, alleviated the symptoms of the disease, as well as improved the quality of life and realized reproductive plans.