Authors:
Vercellini P. Crosignani PG. Fadini R. Radici E. Belloni C. Sismondi P.
Institution
Dr. P. Vercellini, Clin. Ostet. Ginecol. L. Mangiagalli, Universita di
Milano, Via Commenda 12, 20122 Milano; Italy.
Title:
A gonadotrophin-releasing hormone agonist compared with expectant management after conservative surgery for symptomatic endometriosis. (1999)
Source:
British Journal of Obstetrics and Gynaecology. Vol 106(7) (pp72-677), 1999.
Abstract:
Objective. To ascertain whether the Frequency of pelvic pain recurrence is reduced and time to symptoms recurrence is prolonged in women with symptomatic endometriosis undergoing conservative surgery and post-operative hormonal therapy compared with women treated with surgery only. Pregnancy rates and time to conception in women wanting children were also evaluated. Design. A multicentre, prospective, randomised controlled study. Setting. Nineteen Italian academic departments and teaching hospitals specialising in reparative and reconstructive surgery. Population. A total of 269 women undergoing conservative surgery for mild to severe symptomatic endometriosis. Methods. After surgery the women were assigned to treatment with subcutaneous goserelin depot injections for six months or to expectant management. Dysmenorrhoea, deep dyspareunia, nonmenstrual pain and general discomfort were graded according to a verbal rating scale from 0 (absent) to 3 (severe) and the scores summed to give a total symptoms score. Only patients with at least one preoperative moderate or severe symptom were enrolled. The women were evaluated regularly for two years. Main outcome measures. Post-operative pain recurrences (total symptoms scores >= 5), time to recurrence, pregnancy rates and time to conception in the two study groups.
Results:
At one- and two-year follow up visits, 14/107 (13.1%) and 19/81 (23.5%) patients had moderate or severe symptoms recurrence in the goserelin group compared with, respectively, 22/103 (21.4%) and 27/74 (36.5%) in the expectant management group (P = 0.143 at 1 year and 0.082 at 2 years). Time to symptoms recurrence was significantly longer in the goserelin group according to survival analysis (Wilcoxon test, P = 0.041). Among women wanting children, few conceptions occurred in both the goserelin (8/69, 11.6%) and the expectant management group (14/76, 18.4%). There was no significant difference at survival analysis (Wilcoxon test, P = 0.427).
Conclusion:
Post-operative treatment with goserelin significantly prolonged the pain-free interval after conservative surgery for symptomatic endometriosis and did not influence reproductive prognosis.
Please click on the required question.
- Pelvic Pain. Is this a common problem?
- What are the common causes of pelvic pain in women?
- What are the more common gynaecological causes of pelvic pain?
- What are the more common non-gynaecological causes of pelvic pain?
- What are primary and secondary dysmenorrhoea - painful periods?
- What is retrograde menstruation?
- How can dysmenorrhoea - painful periods be treated?
- What are ovarian cysts?
- How do ovarian cysts cause pain?
- How are ovarian cysts diagnosed?
- How are ovarian cysts treated?
- I think I may be pregnant and I have some pelvic pain. What should I do?
- What is pelvic inflammatory disease and how can it be treated?
- Mittelschmertz
- 14 What are fibroids?
- 15 I have fibroids. What difficulties might they cause for me?
- 16 How are fibroids diagnosed?
- 17 How could my fibroids be treated?
- 18 What is endometriosis?
- 19 How prevalent is endometriosis?
- 20 What causes endometriosis?
- 21 How can my endometriosis be treated?
- 22 How can my doctor determine the cause of my pelvic pain?
- 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
- 24 What is laparoscopy?
- 25 What are pelvic adhesions?
- 26 I have chronic pelvic pain. Could this be related to adhesions?
- 27 What is uterine retroversion (retroverted uterus)
- 28 Does a retroverted uterus (backward tilted uterus) cause symptoms?
- 29 How is a retroverted uterus - backward tilted uterus - treated?
- 30 What is pelvic congestion?
- 31 What causes pain associated with sexual intercourse (dyspareunia)
- 32 How can painful sexual intercourse (dyspareunia) be treated?
- 33 What is a pelvic mass?
- 34 What is irritable bowel syndrome?
- 35 How can we find out if I have irritable bowel syndrome?
- 36 Is irritable bowel syndrome (IBS) a common condition?
- 37 What causes IBS?
- 38 What is the pain associated with IBS like?
- 39 Can IBS be mistaken for gynaecological problems?
- 40 How can my IBS be treated?
- 41 What other treatments are available for IBS?
- 42 What can be done to reduce the amount of bowel gas(flatus)
- 43 What is constipation?
- 44 What causes constipation?
- 45 How can constipation be treated?
- 46 How could we summarise the treatments that are available for my pelvic pain?
- 47 Where can I obtain more information?
- 48 Pelvic Pain Support Groups.
- 49 Endometriosis Support Groups.
- 50 IBS Support Groups.
FIBROIDS
ENDOMETRIOSIS
IRRITABLE BOWEL SYNDROME - IBS
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