Postoperative management of reproductive-aged patients with endometrioid ovarian cysts

Objective: To assess the long-term results of hormone treatment in patients after laparoscopic cystectomy for endometrioid ovarian cyst. Materials and methods: The observational study included 56 reproductive-aged patients after cystectomy for endometrioid cysts. Forty-one (74.4%) patients in Group 1 took dienogest (Zafrilla) at a daily dose of 2 mg. The therapy duration was 24 weeks. Eight (13.9%) patients in Group 2 used Siluette containing dienogest 2 mg for contraception. Seven (11.6%) patients in Group 3 received therapy with gonadotropin-releasing hormone analogues at a dose of 3.75 mg (1 injection) intramuscularly every 28 days for 6 months. A follow-up was continued after 3 and 6 months. The investigators studied the intensity of pain syndrome using a visual analogue scale (VAS) before treatment and during control visits, reproductive outcomes, recurrence of cysts, and side effects (adverse events) of the drugs used. Results: The intensity of pain syndrome was observed to decrease in all the patients during the performed therapy following 3 and 6 months. The rate of pregnancy onset in Group 1 was comparable to that in the gonadotropin-releasing hormone agonist group (17/41 (41.5%) versus 3/7 (42.8%)). Disease relapse was noted in 3/41 (7.3%) women in Group 1, in 2/8 (25%) patients in Group 2, and in 1/7 (14.2%) in Group 3. Adverse events in the patients of all the groups were not an indication for medication discontinuation, were relieved symptomatically, or stopped at later stages of treatment. Conclusion: Depending on the reproductive motivations of patients, they used different drugs in each age group. In this case, it is necessary to take into account the tolerability of a particular drug. Dienogest occupies its own niche in the therapy of endometriosis-associated pelvic pain, dysmenorrhea, and dyspareunia as a long-term postoperative therapy in patients with endometrioid ovarian cysts.

endometrioid ovarian cyst, dienogest, recurrence, pain, gonadotropin-releasing hormone analogues, pregnancy, adverse events