Comparison of suppressive hormonal therapy(Low dose oral contraceptive)with aspiration in regression of ovarian endometrioma

Abstract

Background:. Endometriosis is a benign estrogen dependent disease characterized by the presence of endometrial tissue outside the uterus.There are debates regarding the treatment of ovarian endometrioma which depends on various factors such as ovarian reserve before treatment, cyst location, patient's age, and previous treatment. Since medical therapies reduce the symptoms of ovarian endometrioma, different surgical therapies also have been proposed; however, as most of these methods end in lowered ovarian reserve, this study was conducted to investigate and compare the effects of LD contraceptive with aspiration in regression of ovarian endometrioma. Materials and Methods:. This clinical trial was conducted on 50 women aged 15-45 years who had referred to Al-Zahra Hospital with the ultrasound diagnosis of unilateral ovarian endometrioma ≤6 cm and CA 125test <100 unites/ml. Written consent was obtained and the participants were randomly assigned to drug therapy and cyst aspiration groups. The former received one LD contraceptive tablet daily for 3 consecutive months and in the latter, ultrasound-guided cyst aspiration was conducted by an infertility subspecialist. All of the patients were followed up for 6 months in terms of clinical symptoms and cyst regression/recurrence. The data were analyzed in SPSS 25. Results: Findings showed that post-treatment clinical state of the patients (dyspareunia, dysmenorrhea and pelvic pain) was generally improved in both groups(Pvalue< 0.001), though dysmenorrhea and pelvic pain reduction was significantly higher in those received LD contraceptive pills. The rate of cyst recurrence over 6 months was remarkable in the aspiration group (0% in the drug therapy group vs.44% in the aspiration group, P value< 0.001).