Postoperative administration of monophasic combined oral contraceptives after laparoscopic treatment of ovarian endometriomas: A prospective, randomized trial

OBJECTIVE: We sought to evaluate the efficacy of postoperative administrati on of monophasic, combined, low-dose oral contraceptives on endometrioma re currence and on persistence-recurrence of associated pain symptoms after la paroscopic treatment of moderate-to-severe endometriosis. STUDY DESIGN: In a prospective, randomized trial 70 patients who were not a ttempting to conceive, aged 20 to 35 years, underwent laparoscopic excision of ovarian endometriomas, followed by either postoperative administration of low-dose cyclic oral contraceptives for 6 months or no treatment on the basis of a computer-generated sequence. At 3 and 6 months after surgery and then at 6-month intervals, both groups underwent ultrasonographic examinat ion for possible evidence of endometrioma recurrence and for evaluation of the absence, persistence, or recurrence of pain symptoms. RESULTS: Two patients in the oral contraceptive group did not complete the study. After a mean follow-up of 22 months (range, 12-48 months), there wer e 2 (6.1%) endometrioma recurrences in the 33 patients who received postope rative oral contraceptives versus 1 (2.9%) recurrence in the 35 patients in the control group (not significant). The moderate-to-severe pain recurrenc e rate was 9.1% in the oral contraceptive group versus 17.1% in the control group (not significant). The mean time to recurrence of either symptoms or endometriomas was 18.2 months in the oral contraceptive group versus 12.7 months in the control group. The 12-month cumulative recurrence rate at lif e-table analysis was significantly lower for patients receiving oral contra ceptives versus control subjects, whereas no significant difference was evi dent at 24 and 36 months. CONCLUSION: Postoperative administration of low-dose cyclic oral contracept ives does not significantly affect the long-term recurrence rate of endomet riosis after surgical treatment. A delay in recurrence is evident at life-t able analysis.