Post-operative GnRH analogue treatment after conservative surgery for symptomatic endometriosis stage III-IV: a randomized controlled trial

BACKGROUND: In order to decrease endometriosis recurrence after surgical th erapy, it has been proposed to use a post-surgical oestrogen-lowering medic al treatment. Results from previous trials on this topic are contradictory. METHODS: A total of 89 women were randomized, by computer-generated list, after laparoscopic conservative surgery for symptomatic endometriosis stage III-IV to receive monthly i.m. injections of gonadotrophin-releasing hormo ne (GnRH) analogue, leuprolide acetate depot (3.75 mg) for 3 months (n = 44 ) or to an expectant management (n = 45). All patients were followed up eve ry 6 months for evaluation of pain symptoms, fertility and objective diseas e recurrence. RESULTS: During the follow-up, which ranged from 6-36 months, five (33%) of the 15 women who wanted children and who were allocated the GnRH analogue and six (40%) of the 15 given no treatment became pregnant (n ot significant). Moderate/severe pelvic pain recurred during the follow-up in 10 (23%) of the women allocated the GnRH analogue and 11 (24%) of those allocated no treatment; the cumulative pain recurrence rates at 18 months w ere 23 and 29% respectively (not significant). Four women (9%) treated with GnRH analogue and four women (9%) who received no treatment had objective disease recurrence as demonstrated by gynaecological examination and/or pel vic ultrasonography. CONCLUSIONS: This study does not support the routine p ost-operative use of a 3 month course of GnRH analogue in women with sympto matic endometriosis stage III-IV.