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Hum. Reprod. Advance Access originally published online on July 22, 2009
Human Reproduction 2009 24(11):2729-2735; doi:10.1093/humrep/dep259
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© The Author 2009. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Post-operative use of oral contraceptive pills for prevention of anatomical relapse or symptom-recurrence after conservative surgery for endometriosis

R. Seracchioli1, M. Mabrouk, L. Manuzzi, C. Vicenzi, C. Frascà, A. Elmakky and S. Venturoli

Minimally Invasive Gynaecological Surgery Unit, Reproductive Medicine Unit, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy

1 Correspondance address. Tel: +39-051-6363944; Fax: +39-051-6363944, E-mail: seracchioli{at}aosp.bo.it

BACKGROUND: Endometriosis recurrence after conservative surgery is not infrequent. Variable regimens of hormonal therapy have been proposed as adjuvant post-operative measures for prophylaxis against recurrence. Among these, the combined oral contraceptive pills (OCP), represents a valuable option in terms of safety and tolerability for long-term use. The objective of this review is to evaluate the effect of post-operative use of OCP in preventing symptom recurrence, and/or anatomical relapse of endometriosis.

METHODS: A systematic search of Medline identified seven studies evaluating post-operative OCP treatment on prevention of endometriosis recurrence.

RESULTS: A reduction in anatomical relapse rate was observed when oral contraceptive therapy was administered for more than 1 year after conservative surgery. Post-operative use of OCP was associated with a reduction in frequency and intensity of dysmenorrhoea recurrence. No association was found between OCP therapy and dyspareunia prevention, although the effect of OCP on chronic pelvic pain was conflicting.

CONCLUSION: Long-term OCP therapy can be a reliable adjuvant post-operative measure to prevent or reduce frequency/severity of recurrent dysmenorrhoea and anatomical relapse of endometriosis. Since both continuous and cyclic OCP administration regimens seem to have comparable effects, the choice of regimen can be modulated according to patient preferences. The protective effect seems to be related to the duration of treatment.

Key words: endometrioma/pain/dysmenorrhoea/dyspareunia/chronic pelvic pain

Submitted on February 26, 2009; resubmitted on June 23, 2009; accepted on June 25, 2009.


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