The Concept of Endometriosis as Chronic Disease: Surgical and Medical Therapy with Hormonal and Nonhormonal Targets and the Influence of Endometriosis on Obstetrical Outcome

Abstract

AbstractLooking for the most effective treatment of genital endometriosis we established a randomized clinical study which clearly shows that today the best results are achieved with a combined surgical and hormonal treatment, in relation to the recurrence of symptoms and pregnancy.Endometriosis is the second most common gynecological disease in women of reproductive age. Unspecific symptoms reflect the diversity of pathological extent and localization as well as individual reaction to the disease. All suggested classifications are limited in their predictive value. 1. This first part of this study evaluates three different therapy strategies (hormonal medication, surgical, or combined treatment) and discusses the influence of endometriosis on pregnancy outcome. Methods: Four hundred and fifty patients with genital endometriosis, aged 18–44 years, were randomly distributed to three treatment groups at the first laparoscopy. They were reevaluated at a second-look laparoscopy (D 426/10), 1–2 months after the 3-month hormonal therapy for groups 1 and 3 and 5–6 months later for group 2 (surgical treatment alone). Outcome data focused on the recurrence and pregnancy rate. The three treatment options—independent of the initial Endoscopic Endometriosis Classification (EEC) stage including deep infiltrating endometriosis (DIE)—achieved an overall cure rate of 50% or higher. A cure rate of 60% was achieved by the combined treatment, of 55% by the exclusively hormonal therapy, and of 50% by the exclusively surgical treatment. An overall pregnancy rate between 55 and 65% was achieved with no significant difference in relation to the therapeutical option. 2. The consideration of Pregnancy and Endometriosis led to the following conclusions: (1) Increased risk for premature deliveries and pregnancy complications, (2) More frequent pre-eclampsia and antepartum hemorrhage, (3) Increased rate of Cesarean sections, (4) Severe pain in pregnancy continues in quite a few patients, (5) Obstetricians should be aware of obstetric emergencies, such as direct bleeding from lesions, bleeding from uterine arteries or veins, interruption of ureter, and severe peritoneal decidualized endometriosis. Summary: In the battle for the most effective current treatment of genital endometriosis, this clinical randomized study shows the lowest incidence of recurrences for the combined surgical and medical treatment and improved pregnancy rates for any medically treated patients with or without surgery. The highest cure rate of endometriosis was achieved in the combined group.An increased risk for premature deliveries endangers the obstetrical outcome in endometriosis patients.KeywordsPregnancy RatePreterm BirthExtrauterine PregnancyUterine ArteryGnRH AgonistThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.