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Objective To describe strategy and results of fertility preservation (FP) in patients with malignant and borderline ovarian tumors. Methods Consecutive cohort study of 43 women with malignant or borderline ovarian tumors who underwent FP between February 2013 and July 2019. The study was conducted in national expert center in Tenon University Hospital, Sorbonne University: French ESGO-certified ovarian cancer center and pregnancy-associated cancer network (CALG). Main outcome measure was FP technique proposed by multidisciplinary committee, FP technique used, time after surgery, number of fragments, histology and follicle density (if ovarian tissue freezing), number of expected, retrieved and frozen oocytes (if ovarian stimulation). Results Pathological diagnosis was malignant epithelial ovarian tumor in five women (11.6%), rare malignant ovarian tumor in 14 (32.6%), borderline in 24 (55.8%), and mostly unilateral (79.1%) and stage I (76.7%). Mean age at diagnosis was 26.8 ± 6.9 years and mean tumor size 109.7 ± 61 mm. Before FP, mean AFC was 11.0 ± 6.1 and AMH levels were 2.7 ± 4.6 ng/mL. Six ovarian tissue-freezing procedures were performed (offered to 13). Twenty-four procedures of ovarian stimulation and oocyte freezing were performed after surgical treatment for 19 women (offered to 28) with a median interval of 188 days. The mean number of mature oocytes retrieved per stimulation was 12.4 ± 12.8. At least 10 mature oocytes were frozen for 52.6% of the women. No FP was offered to five women. Conclusion Oocyte and ovarian tissue cryopreservation should be offered to patients with malignant and borderline ovarian tumors. More data are needed to confirm ovarian stimulation and ovarian tissue grafting safety.

The available literature, from 2006 to 2017, on hormonal treatment has been analysed as a contribution to the HAS-CNGOF task force for the treatment of endometriosis. Available data are heterogeneous and the general level of evidence is moderate. Hormonal treatment is usually offered as the primary option to women suffering from endometriosis. It cannot be used in women willing to conceive. In women who have not been operated, the first line of hormonal treatment includes combined oral contraceptives (COC) and the levonorgestrel-releasing intra uterine system (52mg LNG-IUS). As a second line, desogestrel progestin only pills, etonogestrel implants, GnRH analogs (GnRHa) with add back therapy and dienogest can be offered. Add back therapy should include estrogens to prevent bone loss and improve quality of life, it can be introduced before the third month of treatment to prevent side effects. The literature does not support preoperative hormonal treatment for the sole purpose of reducing complications or recurrence, or facilitating surgical procedures. After surgical treatment, hormonal treatment is recommended to prevent pain recurrence and improve quality of life. COCs or LNG IUS are recommended as a first line. To prevent recurrence of endometriomas COC is advised and maintained as long as tolerance is good in the absence of pregnancy plans. In case of dysmenorrhea, postoperative COC should be used in a continuous scheme. GnRHa are not recommended in the sole purpose of reducing endometrioma recurrence risk.

Resume Objectif L’objectif de ce travail est d’evaluer la place des nouveaux traitements dans la prise en charge de l’endometriose en dehors du contexte d’infertilite. Methodes Une revue de la litterature a ete effectuee en consultant les donnees Medline jusqu’en juillet 2017. Resultats Le dienogest est efficace par rapport au placebo a court terme (NP2) et long terme (NP4) pour le traitement de l’endometriose douloureuse. En comparaison aux agonistes de la GnRH, le dienogest est aussi efficace en termes de diminution de douleur et d’amelioration de la qualite de vie chez les patientes non operees (NP2), de meme que pour la recidive des lesions d’endometriose et la symptomatologie en postoperatoire (NP2). Les donnees concernant les antagonistes de la GnRH, les modulateurs selectifs des recepteurs a la progesterone de meme que les inhibiteurs selectifs (anti-TNF-α, inhibiteurs des metalloproteases matricielles, inhibiteurs des facteurs de croissance de l’angiogenese) sont insuffisantes pour apporter une preuve de l’interet en pratique clinique pour la prise en charge de l’endometriose douloureuse (NP3). Conclusion Le dienogest est recommande en seconde intention pour la prise en charge de l’endometriose douloureuse (Grade B). En l’absence de donnees suffisantes, les anti-aromatases, l’elagolix, les SERM, les SPRM et les anti-TNF-α ne sont pas recommandes pour la prise en charge de l’endometriose douloureuse (Grade C).

Resume Objectif Etablir des recommandations de bonne pratique pour la prise en charge medicale de l’endometriose douloureuse chez les patientes sans infertilite. Methodes Revue de la litterature depuis 2006, etablissement des niveaux de preuve, relecture externe et gradation des recommandations par un groupe d’expert selon la methodologie de la HAS. Resultats Les traitements hormonaux recommandes en premiere intention pour le traitement de l’endometriose douloureuse sont la contraception par oestro-progestatifs (COP) et le systeme intra-uterin au levonorgestrel 52 mg (SIU au LNG) (grade B). Les traitements recommandes en deuxieme intention sont la contraception microprogestative au desogestrel, l’implant a l’etonogestrel, les agonistes de la GnRH (GnRHa) et le dienogest (grade C). En cas de prescription de GnRHa, il est recommande de prescrire une add-back therapie comportant un estrogene (grade B). En postoperatoire, hors desir de grossesse, il est recommande de prescrire un traitement hormonal par COP ou SIU au LNG en premiere intention (grade B). Apres chirurgie d’endometriome, la COP est recommandee pour reduire le risque de recidive (grade B) mais la prescription de GnRHa n’est pas recommandee dans ce but (grade C). La COP en prise continue est recommandee en cas de dysmenorrhee (grade B). Chez les adolescentes, la prescription de GnRHa n’est pas recommandee en premiere intention en raison des risques de demineralisation osseuse (grade B). L’endometriose est responsable de douleurs chroniques dont la prise en charge necessite une evaluation interdisciplinaire. Les therapeutiques non-medicamenteuses ameliorant la qualite de vie peuvent etre proposees (accord d’expert). D’autres therapeutiques medicamenteuses sont actuellement en cours d’evaluation.

Resume Objectif Analyser la litterature sur le traitement de l’endometriose douloureuse de l’adolescente. Methode Revue de la litterature entre janvier 2006 et decembre 2017. La recherche bibliographique etait realisee sur les bases de donnees Medline (Pubmed) et Cochrane database. Les meta-analyses, revues de la litterature, essais randomises controles, etudes de cohorte et etudes retrospectives etaient retenues. Les etudes traitant des dysmenorrhees de l’adolescente sans endometriose etaient exclues. Resultats Les etudes sont de qualite heterogene. Le dienogest et les agonistes de la GnRH (GnRHa) sont les seuls traitements evalues specifiquement pour le traitement de l’endometriose chez l’adolescente. Ils permettent une reduction des douleurs liees a l’endometriose. Les contraceptifs oestroprogestifs sont efficaces sur les dysmenorrhee de l’adolescente mais n’ont pas ete etudies dans les contextes d’endometriose. La densite minerale osseuse et la qualite de vie des patientes traitees par GnRHa est significativement meilleure sous add-back therapie comportant un œstrogene. Conclusion Le traitement medical de l’endometriose de l’adolescente comporte des specificites et des risques liees a l’âge. Le choix du traitement doit tenir compte des effets indesirables de chaque molecule.

Background: Cancer genetics clinics are struggling to cope with increasing referrals of breast and ovarian cancer (BC/OC) patients The approval of anti-PARP for cases with germline BRCA1/2 pathogenic variants (PV) and the associated necessity for the oncologist to receive results rapidly are compounding these difficulties Mainstreamed genetic testing (MGT) via oncologists and gynecologists obviates the need for a genetics consultation for most patients, as only complex cases and PV carriers are referred We report results from an MGT project involving a Paris University hospital and two regional hospitals, and show how MGT guaranteed care continuity during the COVID-19 pandemic Methods: Oncologists and gynecologists participated voluntarily They were sent an e-learning module summarizing the principles of genetic susceptibility to BC/OC, patient selection, consent, carrier management, and highlighting the importance of cascade testing in relatives A computerized and adapted version of the Manchester Scoring System was used for patient selection Only index cases with cancer and aged > 30 were included The oncologist or gynecologist provided basic genetic counseling and gave patients an information sheet A single academic laboratory performed all analyses Results: During the 01 2018 – 05 2020 period, MGT was carried out in 244 patients with an average age of 51 PV detection rate in the BRCA1/2, PALB2, and RAD51C/D major genes was 11% All carriers were subsequently seen by a cancer geneticist Whenever possible, patients with negative results were discussed at a multidisciplinary meeting involving a geneticist or a genetic counselor 27 of the reported patients had MGT during the 8-week COVID-19 lockdown Conclusions: We report the successful implementation of MGT in France for BC/OC patients It allowed for immediate testing at their point of care of eligible patients Results were rapidly returned, and all PV carriers were seen by a cancer geneticist The PV detection rate was similar to rates observed using traditional testing pathways Of note, MGT guaranteed continuity of care during the COVID-19 lockdown, when all medical activity considered nonessential, including cancer genetics, was drastically reduced Legal entity responsible for the study: The authors Funding: Has not received any funding Disclosure: All authors have declared no conflicts of interest

The available literature, from 2006 to 2017, on hormonal treatment has been analysed as a contribution to the HAS-CNGOF task force for the treatment of endometriosis. Available data are heterogeneous and the general level of evidence is moderate. Hormonal treatment is usually offered as the primary option to women suffering from endometriosis. It cannot be used in women willing to conceive. In women who have not been operated, the first line of hormonal treatment includes combined oral contraceptives (COC) and the levonorgestrel-releasing intra uterine system (52mg LNG-IUS). As a second line, desogestrel progestin only pills, etonogestrel implants, GnRH analogs (GnRHa) with add back therapy and dienogest can be offered. Add back therapy should include estrogens to prevent bone loss and improve quality of life, it can be introduced before the third month of treatment to prevent side effects. The literature does not support preoperative hormonal treatment for the sole purpose of reducing complications or recurrence, or facilitating surgical procedures. After surgical treatment, hormonal treatment is recommended to prevent pain recurrence and improve quality of life. COCs or LNG IUS are recommended as a first line. To prevent recurrence of endometriomas COC is advised and maintained as long as tolerance is good in the absence of pregnancy plans. In case of dysmenorrhea, postoperative COC should be used in a continuous scheme. GnRHa are not recommended in the sole purpose of reducing endometrioma recurrence risk.

To provide clinical practice guidelines for the management of painful endometriosis in women without infertility.Systematic review of the literature literature since 2006, level of evidence rating, external proofreading and grading of the recommendation grade by an expert group according to HAS methodology.Combined hormonal contraceptives (COP) and the levonorgestrel-releasing intra-uterin system (LNG-IUS) are recommended as first-line hormonal therapies for the treatment of painful endometriosis (grade B). Second-line therapy relies on oral desogestrel microprogestative, etonogestrel-releasing implant, GnRH analogs (GnRHa) and dienogest (grade C). It is recommended to use add-back therapy containing estrogen in association with GnRHa (grade B). After endometriosis surgery, hormonal treatment relying on COP or LNG-IUS is recommended to prevent pain recurrence (grade B). COP is recommended to reduce the risk of endometrioma recurrence after surgery (grade B) but the prescription of GnRHa is not recommended (grade C). Continuous COP is recommended in case of dysmenorrhea (grade B). GnRHa is not recommended as first line endometriosis treatment for adolescent girl because of the risk of bone demineralization (grade B). The management of endometriosis-induced chronic pain requires an interdisciplinary evaluation. Physical therapies improving the quality of life such as yoga, relaxation or osteopathy can be proposed (expert agreement). Promising medical alternatives are currently under preclinical and clinical evaluation.

To analyse the literature on the treatment of adolescent painful endometriosis.This work is based on a Review of the literature between January 2006 and December 2017. The Medline (Pubmed) and Cochrane database were searched for meta-analyzes, randomized trials, literature reviews, controlled, not controlled and retrospective studies published on the subject. Studies concerning adolescent's dysmenorrhea without endometriosis were excluded.Study quality is heterogeneous. Dienogest and GnRH agonists (GnRHa) are the only treatments specifically evaluated for the treatment of adolescent endometriosis. They reduce the pain associated with endometriosis. Combined oral contraceptives have not been studied in the context of endometriosis but they are effective on dysmenorrhea. Add back therapy, containing estrogens improves bone mineral density and quality of life for young women treated with GnRHa.Medical treatment of endometriosis in adolescent is associated with risks related to the young age. The therapeutic strategy should take into account the adverse effects of each treatment.

The objective of this work is to evaluate the place of new treatments in the management of endometriosis outside the context of infertility.A review of the literature was conducted by consulting Medline data until July 2017.Dienogest is effective compared to placebo in short term (NP2) and long term (NP4) for the treatment of painful endometriosis. In comparison with GnRH agonists, dienogest is also effective in terms of decreased pain and improved quality of life in non-operated patients (NP2) as well as for recurrence of lesions and symptomatology postoperatively (NP2). Data on GnRH antagonists, selective progesterone receptor modulators as well as selective inhibitors (anti-TNF-α, matrix metalloprotease inhibitors, angiogenesis growth factor inhibitors) are insufficient to provide evidence of interest in clinical practice for the management of painful endometriosis (NP3).Dienogest is recommended as second-line therapy for the management of painful endometriosis (Grade B). Because of lack of evidence, aromatase inhibitors, elagolix, SERM, SPRM and anti-TNF-α are not recommended for the management of painful endometriosis (Grade C).