Continuous versus cyclic oral contraceptives after laparoscopic excision of ovarian endometriomas: a systematic review and metaanalysis
| Autor: | Pierluigi Benedetti Panici, Angela Musella, Chiara Achilli, Chiara Di Tucci, Violante Di Donato, Innocenza Palaia, Ludovico Muzii |
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| Rok vydání: | 2016 |
| Předmět: |
Oral
0301 basic medicine medicine.medical_specialty laparoscopy Endometriosis Pelvic Pain law.invention 03 medical and health sciences 0302 clinical medicine Dysmenorrhea Randomized controlled trial law Internal medicine medicine Humans medical treatment Ovarian Diseases 030212 general & internal medicine Laparoscopy oral contraceptives endometrioma endometriosis Contraceptives Oral Dyspareunia Female Quality of Life Treatment Outcome 030219 obstetrics & reproductive medicine medicine.diagnostic_test business.industry General surgery Pelvic pain Obstetrics and Gynecology Contraceptives General Medicine Laparoscopic excision medicine.disease Confidence interval Surgery Regimen 030104 developmental biology Meta-analysis Relative risk medicine.symptom business Cohort study |
| Zdroj: | American Journal of Obstetrics and Gynecology. 214:203-211 |
| ISSN: | 0002-9378 |
| DOI: | 10.1016/j.ajog.2015.08.074 |
| Popis: | In the lack of evidence consistently supporting the use of continuous vs cyclic oral contraceptives after surgery for endometriosis, we conducted a systematic review and metaanalysis with the objective of comparing a continuous vs a cyclic oral contraceptive schedule administered after surgical excision of ovarian endometriomas. A PubMed, MedLine, and Embase search through December 2014 was conducted, with the use of a combination of key words and text words related to endometrioma, endometriosis, oral contraceptives, oral estroprogestins, laparoscopy, and surgery. Studies directly comparing a continuous vs a cyclic schedule administered after surgical treatment of endometriomas were included, with pain and endometrioma recurrence rates as the primary outcomes. Three reviewers independently assessed methodology and extracted data from selected studies. The primary outcomes were considered pain recurrence (evaluated separately for dysmenorrhea, noncyclic chronic pelvic pain, and dyspareunia) and endometrioma recurrence evaluated at ultrasonography. Dichotomous outcomes from each study were expressed as risk ratio (RR) with a 95% confidence interval (CI). Three randomized clinical trials and 1 prospective controlled cohort study were included, for a total of 557 patients with endometriosis, 343 patients of whom had ovarian endometriomas completing the assigned treatment and follow-up. Lower recurrence rates for dysmenorrhea were obtained with a continuous schedule (RR, 0.24; 95% CI, 0.06–0.91; P = .04). Nonsignificant differences were present for chronic pelvic pain and dyspareunia. A continuous oral contraceptive schedule was associated with a nonsignificant reduction of cyst recurrence rates compared with a cyclic schedule (RR, 0.54; 95% CI, 0.28–1.05; P = .07). A continuous oral contraceptive regimen, as opposed to a cyclic regimen, may be suggested after surgery for endometriomas because of lower dysmenorrhea recurrence rates. Due to the small number and small sample sizes of the included studies, further randomized clinical trials are needed to confirm the findings of the present systematic review. Also, outcomes related to patient satisfaction and quality of life should be addressed. |
| Databáze: | OpenAIRE |
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