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Objectives To determine the impact of postoperative dienogest on recurrence of endometriosis following conservative surgery. Methods The following databases were searched from inception to March 2019: Ovid MEDLINE, Ovid EMBASE, PubMed (Non-Medline records only), EBM Reviews - Cochrane Central Register of Controlled Trials, Web of Science, LILACS, clinicaltrials.gov and International Standard Randomised Controlled Trial Number Registry. Observational and randomized controlled studies with pre-menopausal women undergoing conservative surgery for endometriosis followed by post-operative dienogest treatment for at least 6 months were included. Primary outcome was the rate of endometriosis/endometrioma recurrence. For studies with a comparator group, we compared post-operative suppression with dienogest to no treatment. Results After screening 328 studies, 10 met inclusion criteria (9 retrospective, 1 prospective) representing 2031 patients (1184 treated, 846 controls). Among patients treated with dienogest, there were 2.11 recurrences per 100 women (95% CI: 1.43 to 3.11, 10 studies, 1184 patients, I2 = 0% fixed effects model). Comparatively, those managed expectantly had a significantly higher incidence of disease recurrence (28.61 events/100 women; 95% CI: 25.66 to 31.74, 6 studies, 846 patients, I2 = 83% fixed effects model). The odds of recurrence were significantly lower in women treated with dienogest compared to those without postoperative medical treatment (log odds -1.96, 95% CI -2.53 to -1.38, p Conclusions Women treated with dienogest following conservative endometriosis surgery have a significantly lower rate of disease recurrence compared to those not receiving post-operative hormonal suppression.

Objectives The administration of multiple repeat courses of antenatal corticosteroids (ACS) in pregnant patients who remain undelivered after initial ACS administration has not been shown to have clear benefit, and may have associated harms. This study aims to review the literature on the impact of a single “rescue” course or dose of ACS in patients who remain undelivered >7 days following administration of an initial course. Methods We conducted a comprehensive search of electronic databases, clinical trial registries, and reference lists of relevant publications. RCTs and observational studies published from 1972 that assessed neonatal outcomes after administration of a rescue course or dose of ACS compared to a single course were included. Two reviewers independently screened studies for inclusion and assessed risk of bias. Data was extracted by one reviewer. Results were synthesized narratively. Results A total of 1978 references were screened; three RCTs and four observational studies met inclusion criteria. These differed in gestational age ranges included, time elapsed between initial and rescue ACS, and inclusion of multiple pregnancies. Four studies investigated a rescue course and two studied a rescue dose; one study combined those groups. One study showed a significant decrease in mortality with rescue ACS, and two found decreased respiratory distress syndrome with a rescue course. None showed a significant difference in birthweight with rescue ACS. Conclusions While these results suggest that rescue ACS may be beneficial and not harmful compared to a single course, the results are limited due to the heterogeneity of the literature. Further well-designed studies are needed.

Study Objective To determine the impact of postoperative hormonal suppression with dienogest on recurrence of endometriosis following conservative endometriosis surgery. Design We performed a meta-analysis and systematic review of observational (retrospective and prospective) studies and randomized controlled trials. Setting The following databases were search from inception to March 2019: Ovid MEDLINE, Ovid EMBASE, PubMed (Non-Medline records only), EBM Reviews - Cochrane Central Register of Controlled Trials, Web of Science, LILACS, clinicaltrials.gov and International Standard Randomised Controlled Trial Number Registry. Patients or Participants We included studies of pre-menopausal women undergoing conservative surgery for endometriosis followed by post-operative dienogest suppression for at least 6 months. Interventions Post-operative suppression with dienogest for at least 6 months duration. Measurements and Main Results Primary outcome was the rate of endometriosis/endometrioma recurrence on imaging. For studies with a comparator group, we compared post-operative suppression with dienogest to no treatment. We screened 361 studies and 11 met inclusion criteria (10 retrospective and 1 prospective cohort studies). These studies included 2243 patients (1314 treated with dienogest and 929 controls). Treatment duration ranged from 6 months to 79 months post-operatively. The mean follow-up period ranged from 6 months for 1 study to 60 months for another, with the remaining 9 studies reporting follow-up periods ranging from 12 months to 43 months. For patients treated with dienogest there were 3 recurrences per 100 women (2.92 events/100 women, 95% CI 2.08, 4.10; 11 studies, 1314 patients, I2=21%, fixed effects model). The odds of recurrence were significantly lower in women treated with dienogest compared to no post-operative hormonal suppression (Log odds -2.09, 95%CI -2.59, -1.59, p Conclusion Post-operative hormonal suppression with dienogest following endometriosis surgery is associated with a low overall recurrence rate, and is superior to no post-operative suppression.

Women commonly report increased cravings for foods high in sugar, fat, and/or salt premenstrually relative to other times during the menstrual cycle. To determine if elevated cravings for foods high in salt and/or fat were related to alterations in food preferences across the menstrual cycle, preference and sensory ratings for air-popped popcorn with varying levels of salt (0.0, 1.5, and 4.0 g) and butter (3.3, 10, and 30 g) added to 30 g of popcorn were assessed in 34 normal-weight, college-aged women for 4 consecutive weeks. Additionally, using the Profile of Mood Scale (POMS), mood states were determined across the menstrual cycle. Dietary restraint, disinhibition, and hunger were assessed using the Three Factor Eating Questionnaire (TFEQ). Neither preference ratings nor ratings of the saltiness or fatness of the popcorn samples varied as a function of the menstrual cycle. Moreover, no differences in mood states were observed across the menstrual cycle. However, preference ratings for the popcorn samples were significantly greater for restrained than unrestrained eaters. Restrained eaters also rated the samples as significantly more salty, and had significantly higher scores on the tension-anxiety and depression-dejection subscale of the POMS than unrestrained eaters. Additionally, preference ratings of women who reported exercising more than 3 h a week were significantly greater than those of women who reported exercising less than 3 h a week. It is hypothesized that the variations in preference ratings observed as a function of dietary restraint and exercise are the result of differences in cognitive beliefs about food, rather than differences in physiological factors.