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Prevention of ovarian endometrioma recurrence: efficacy of long-term maintenance therapy with a Levonorgestrel-releasing intrauterine system

The aim of a study was to evaluate the cumulative recurrence rates of ovarian endometrioma among patients using a Levonorgestrel-releasing intrauterine system ( LNG-IUS ) after conservative laparoscopic surgery.

A retrospective review was conducted of premenopausal women who underwent conservative laparoscopic surgery for ovarian endometrioma and subsequent treatment with LNG-IUS at two gynecologic surgery centers in South Korea between January 1, 2007, and September 30, 2014.

Eligible patients had no residual ovarian lesions before LNG-IUS insertion, underwent insertion within 12 months of primary surgery, and were followed up for at least 6 months afterwards.
Recurrence was defined as a cystic mass ( greater than or equal to 2 cm in diameter ) detected by transvaginal ultrasonography.

Overall, 61 patients were included. The mean duration of follow-up was 42.9 ± 22.0 months ( range 8-98 ).

Recurrence of ovarian endometrioma was detected among 7 ( 11% ) of the patients.

On Kaplan-Meier analysis, the cumulative recurrence rates were 4.0%, 6.3%, and 25.5% at 24, 36, and 60 months after surgery, respectively.

In multivariate analysis, nulliparity at surgery was the only risk factor for recurrence ( hazard ratio, HR=5.892, 95% confidence interval 1.139-30.484; P=0.034 ).

In conclusion, long-term maintenance therapy with LNG-IUS after conservative surgery might be a treatment option to consider to prevent ovarian endometrioma recurrence among premenopausal women. ( Xagena )

Kim ML et al, Int J Gynaecol Obstet 2016; Epub ahead of print