Combined surgical and hormone therapy for endometriosis is the most effective treatment: prospective, randomized, controlled trial

Abstract

Study objective: To evaluate 3 therapy strategies: hormone therapy, surgery, and combined treatment.

Design: Prospective, randomized, controlled study (Canadian Task Force classification I).

Setting: University-based teaching hospital.

Patients: Four hundred fifty patients with genital endometriosis, aged 18 to 44 years, before first laparoscopy.

Interventions: Patients were randomly assigned to 1 of 3 treatment groups: hormone therapy, surgery, or combined treatment. Patients were reevaluated at second-look laparoscopy, at 2 to 2 months after 3-month hormone therapy in groups 1 and 3 and at 5 to 6 months in group 2 (surgical treatment alone). Outcome data were focussed on the endometriosis stage, recurrence of symptoms, and pregnancy rate.

Measurements and main results: All treatment options, independent of the initial Endoscopic Endometriosis Classification stage, achieved an overall cure rate of ≥50%. A cure rate of 60% was achieved with the combined treatment, 55% with exclusively hormone therapy, and 50% with exclusively surgical treatment. Recurrence of symptoms was lowest in patients who received combined treatment. Significant benefit was achieved for dysmenorrhea and dyspareunia. An overall pregnancy rate of 55% to 65% was achieved, with no significant difference between the therapeutic options.

Conclusion: In the quest to find the most effective treatment of genital endometriosis, this clinical randomized study shows the lowest incidence of recurrence with combined surgical and medical treatment and improved pregnancy rate in any medically treated patients with or without surgery. The highest cure rate (Endoscopic Endometriosis Classification stage 0) for endometriosis was also achieved in the combined treatment group.

Keywords: Combined treatment; Endometriosis; Hormone therapy; Infertility; Laparoscopy; Prospective studies; Recurrence; Reoperation.