Liselotte Mettler
University Hospitals Schleswig-Holstein Campus Kiel ,Germany
Title: Surgical and medical therapy of endometriosis with hormonal and non-hormonal targets
Biography
Biography: Liselotte Mettler
Abstract
Study question: To evaluate 3 therapy strategies - Hormone therapy, surgery, and combined treatment for genital endometriosis in a university based teaching hospital. Summary answer: 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 with the highest cure rate in the combined treatment group. What is already known? Endometriosis is a systemic disease, which needs various treatments as up to date no single treatment is successful in every patient. Study design, size and duration: Four hundred fifty patients with genital endometriosis, stages I-III, aged 18 to 44 years, before first laparoscopy: 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 focused on the endometriosis stage, recurrence of symptoms, and pregnancy rate. Main results and role of chance: All treatment options, independent of the initial Endoscopic Endometriosis Classification stage, achieved an overall cure rate of R50%. 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. Limitations and reasons for caution: Although a good number of patients were included into this RCT, no clear picture of an optimal therapy could be obtained. In this still complex and poorly understood disease therefore all know therapy concepts should be used for the treatment of patients. Wider implications of the findings: After an initial diagnostic laparoscopy, be careful with repetitive laparoscopic surgeries.