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Published on: January 22, 2022
The Effect of Hormonal Treatment on Ovarian Endometriomas: A Systematic Review and Meta-Analysis
Peter S Thiel1, Francesca Donders2, Anna Kobylianskii1
1Department of Obstetrics and Gynecology (Drs. Thiel, Kobylianskii, and Murji), Mount Sinai Hospital, Toronto, ON, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada (Drs. Thiel, Kobylianskii, and Murji).
Objective:
To evaluate the effect of hormonal suppression of endometriosis on the size of endometriotic ovarian cysts.
Data Sources:
The authors searched MEDLINE, PubMed, Cochrane Central Register of Controlled Trials, Embase, and ClinicalTrials.gov from January 2012 to December 2022.
Methods Of Study Selection:
We included studies of premenopausal women undergoing hormonal treatment of endometriosis for ≥3 months. The authors excluded studies involving surgical intervention in the follow-up period and those using hormones to prevent endometrioma recurrence after endometriosis surgery. Risk of bias was assessed with the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool. The protocol was registered in PROSPERO (CRD42022385612).
Tabulation, Integration, And Results:
The primary outcome was the mean change in endometrioma volume, expressed as a percentage, from baseline to at least 6 months. Secondary outcomes were the change in volume at 3 months and analyses by class of hormonal therapy. The authors included 16 studies (15 cohort studies, 1 randomized controlled trial) of 888 patients treated with dienogest (7 studies), other progestins (4), combined hormonal contraceptives (2), and other suppressive therapy (3). Globally, the decrease in endometrioma volume became statistically significant at 6 months with a mean reduction of 55% (95% confidence interval, -40 to -71; 18 treatment groups; 730 patients; p <.001; I2 = 96%). The reduction was the greatest with dienogest and norethindrone acetate plus letrozole, followed by relugolix and leuprolide acetate. The volume reduction was not statistically significant with combined hormonal contraceptives or other progestins. There was high heterogeneity, and studies were at risk of selection bias.
Conclusion:
Hormonal suppression can substantially reduce endometrioma size, but there is uncertainty in the exact reduction patients may experience.
Insights
Hormonal suppression significantly reduces endometrioma size, with an average 55% decrease at six months. Dienogest and other specific therapies showed the greatest effectiveness in shrinking ovarian cysts.
Area of Science:
- Reproductive Endocrinology
- Gynecologic Oncology
Background:
- Endometriosis is a condition characterized by endometrial-like tissue outside the uterus, often leading to ovarian cysts (endometriomas).
- Hormonal therapies are commonly used to manage endometriosis symptoms and disease progression.
Purpose of the Study:
- To systematically evaluate the impact of hormonal suppression on the size of endometriotic ovarian cysts.
- To analyze the efficacy of different classes of hormonal therapies in reducing endometrioma volume.
Main Methods:
- A comprehensive literature search was conducted across major databases (MEDLINE, PubMed, Embase, etc.) from 2012 to 2022.
- Included studies focused on premenopausal women treated with hormonal therapy for endometriosis for at least three months.
- Risk of bias was assessed using established tools, and the protocol was registered with PROSPERO.
Main Results:
- Sixteen studies involving 888 patients were analyzed, with dienogest, progestins, and hormonal contraceptives being common treatments.
- Hormonal suppression led to a statistically significant mean reduction in endometrioma volume of 55% at six months.
- Dienogest and norethindrone acetate plus letrozole demonstrated the most substantial volume reductions, while combined hormonal contraceptives and other progestins showed less significant effects.
Conclusions:
- Hormonal suppression is an effective strategy for substantially reducing the size of endometriotic ovarian cysts.
- While significant reductions are achievable, the precise degree of volume decrease can vary among patients and treatment types.
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