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To evaluate the relationship between anatomic locations and diameter of endometriotic lesions with severity of perimenstrual dyschezia (pain with defecation) as a possible location-indicating pain symptom for posterior deep infiltrating endometriosis (DIE).Retrospective analysis (Canadian Task Force classification II-3).Tertiary care university hospital.We reviewed hospital records of patients who underwent laparoscopic treatment for pelvic endometriosis in our center between 2001 and 2006. In all, 360 patients with posterior DIE (endometrial glands and stroma infiltrated excised tissues of the specified organs) were included for whom preoperative scoring of perimenstrual dyschezia was performed using a 10-point visual analog scale (VAS). Data about anatomic location and diameter of excised nodules were retrieved from operative and pathological records.Laparoscopic excision of suspected endometriotic lesions.Mean VAS score of dyschezia for patients with overall posterior DIE was 3.9 +/- 3.8, whereas in unaffected patients it was 1.9 +/- 3.3 (Mann-Whitney test p.0005). Rectovaginal involvement (posterior vaginal wall, rectovaginal septum, and anterior rectal wall) was found in 240 of 360 women. Mean VAS score for dyschezia was 4.1 +/- 4 and 2.1 +/- 3.3 in affected and nonaffected patients, respectively (p.0005). Mean lesion diameter in affected patients was significantly correlated with mean VAS score (Spearman rho = 0.21). Patients with anterior rectal wall endometriosis (71/240) had a mean VAS score of 4.2 +/- 4 and in nonaffected patients it was 2.7 +/- 3.6 (p.05). Mean lesion diameter in affected patients was not significantly correlated with mean VAS score of dyschezia (Spearman rho = 0.16).Severity of dyschezia was significantly correlated with posterior DIE. A positive correlation occurred between severity of dyschezia and lesion diameter with rectovaginal endometriosis but not with anterior rectal wall involvement.

Objective To evaluate postoperative long-term cyclic and continuous administration of combined oral contraceptive (OC) pills in preventing endometriosis-related pain recurrence. Design Prospective, randomized, controlled trial. Setting Tertiary care university hospital. Patient(s) Three hundred eleven women who underwent laparoscopic excision for symptomatic ovarian endometrioma. Intervention(s) Patients were randomly divided into three groups: nonuser group receiving no therapy, and cyclic user group and continuous user group receiving low-dose, monophasic OC pills for 24 months in either cyclic or continuous administration. Main Outcome Measure(s) Presence and intensity of dysmenorrhea, dyspareunia, and chronic pelvic pain were assessed by a 10-point visual analogue scale (VAS) at 6, 12, 18, and 24 months postoperatively. Result(s) A significant reduction in recurrence rate and VAS scores for dysmenorrhea was evident in the continuous users versus the other groups at 6 months, and in cyclic users versus nonusers at 18 months postoperatively. No significant differences in recurrence rate and VAS scores for dyspareunia and chronic pelvic pain were demonstrated among the groups. The increase of VAS scores from 6–24 months during the study period for dysmenorrhea, dyspareunia, and chronic pelvic pain was significantly higher in nonusers than in the other groups. Conclusion(s) Long-term postoperative use of OC pills can reduce the frequency and the severity of recurrent endometriosis-related dysmenorrhea.

OBJECTIVE: To evaluate long-term cyclic and continuous administration of oral contraceptive pills (OCP) in preventing ovarian endometrioma recurrence after laparoscopic cystectomy. DESIGN: Prospective, randomized, controlled trial. SETTING: Tertiary care University Hospital. PATIENT(S): Two hundred thirty-nine women who underwent laparoscopic excision of ovarian endometriomas. INTERVENTION(S): Patients were divided randomly into three groups: nonusers receiving no therapy and cyclic and continuous users receiving low-dose, monophasic OCP for 24 months in cyclic or continuous administration, respectively. MAIN OUTCOME MEASURE(S): Endometrioma recurrence, size of recurrent endometrioma, and growth rate during at least 2 years follow-up evaluated by transvaginal ultrasonography. RESULT(S): The crude recurrence rate within 24 months was significantly lower in cyclic (14.7%) and continuous users (8.2%) compared with nonusers (29%). The recurrence-free survival was significantly lower in nonusers compared with cyclic and continuous users. The mean recurrent endometrioma diameter at first observation was significantly lower in cyclic (2.17 +/- 0.45 cm) and continuous users (1.71 +/- 0.19 cm) compared with nonusers (2.73 +/- 0.56 cm). The mean diameter increase every 6 months of follow-up was significantly reduced in cyclic users (0.31 +/- 0.18 cm) and continuous users (0.25 +/- 0.09 cm) versus nonusers (0.48 +/- 0.3 cm). No significant differences between cyclic users and continuous users in terms of endometrioma recurrence were demonstrated. CONCLUSION(S): Long-term cyclic and continuous postoperative use of OCP can effectively reduce and delay endometrioma recurrence.

BACKGROUND: Endometriosis recurrence after conservative surgery is not infrequent. Variable regimens of hormonal therapy have been proposed as adjuvant post-operative measures for prophylaxis against recurrence. Among these, the combined oral contraceptive pills (OCP), represents a valuable option in terms of safety and tolerability for long-term use. The objective of this review is to evaluate the effect of post-operative use of OCP in preventing symptom recurrence, and/or anatomical relapse of endometriosis. METHODS: A systematic search of Medline identified seven studies evaluating post-operative OCP treatment on prevention of endometriosis recurrence. RESULTS: A reduction in anatomical relapse rate was observed when oral contraceptive therapy was administered for more than 1 year after conservative surgery. Post-operative use of OCP was associated with a reduction in frequency and intensity of dysmenorrhoea recurrence. No association was found between OCP therapy and dyspareunia prevention, although the effect of OCP on chronic pelvic pain was conflicting. CONCLUSION: Long-term OCP therapy can be a reliable adjuvant post-operative measure to prevent or reduce frequency/severity of recurrent dysmenorrhoea and anatomical relapse of endometriosis. Since both continuous and cyclic OCP administration regimens seem to have comparable effects, the choice of regimen can be modulated according to patient preferences. The protective effect seems to be related to the duration of treatment.