Risk factors associated with endometrioma and those associated with the recurrence of pain following endometriosis surgery are different, according to a study conducted by Japanese scientists. Dominant risk factors should be determined for each patient, and hormone treatment should be prioritized for patients who are at high risk of recurrent pain following surgery.
The study, “Determinant factors of postoperative recurrence of endometriosis: difference between endometrioma and pain,” was published in the European Journal of Obstetrics & Gynecology and Reproductive Biology.
According to Brigham and Women’s Hospital (which was not involved in this study), an endometrioma is a deep ovarian endometriosis that forms dark fluid-filled cavities of varying sizes known as endometriomas, or “chocolate cysts.” Endometriosis can also be located on the surface of the ovaries.
Dr. M. Mandai and colleagues analyzed 352 patients who underwent surgery at Kinki University Hospital in Osaka, Japan, between 2008 and 2013 and who were diagnosed with endometriosis based on pathological findings.
Among the 352 patients, the team focused on 191 who did not undergo hormone treatment before or after surgery. They looked at factors such as tumor diameter, the revised American Society for Reproductive Medicine score (r-ASRM score) used to describe the extent of endometriosis, duration of the surgery, and the amount of blood lost during surgery for all patients.
They found that 28.7 percent of patients experienced a recurrence of endometrioma within five years after surgery, and found significant differences in all parameters analyzed between patients in whom endometrioma recurred and in patients in whom it did not.
They then compared the pain experienced by patients before surgery and improvement of pain following surgery. They found that 33.4 percent had persistent/recurrent pain within five years after the surgery.
Importantly, there was no correlation between factors that determine the likelihood of recurrent endometriosis and those that determine the likelihood of developing pain.
“The determinant factors of recurrence of endometrioma and pain are completely different. Therefore, postoperative management, including hormonal treatment, should be considered according to the individual symptoms of the patient,” the authors wrote.
The European Society of Human Reproduction and Embryology (ESHRE) estimates endometriosis affects 2 to 10 percent of women of reproductive age. Although ESHRE recommends the use of hormone treatment following endometriosis surgery to prevent the recurrence of pain, these results suggest this may not be necessary for all patients.