Oral Presentation

Clinical and paraclinical considerations interesting the hormonal therapy in women with endometriosis

Alexandra Mihaila (RO), Irina Dumitrascu (RO), Alexandra Carp (RO), Roxana Matasariu (RO)

[Mihaila] Clinical Hospital of Obstetrics and Gynecology „Cuza-Voda” Iasi, [Dumitrascu] University of Medicine and Pharmacy “Grigore T. Popa”- Iasi Faculty of Medicine, [Carp] University of Medicine and Pharmacy “Grigore T. Popa”- Iasi Faculty of Medicine, [Matasariu] University of Medicine and Pharmacy “Grigore T. Popa”- Iasi Faculty of Medicine

Purpose of the study: To evaluate the different effects of various hormonal medication, regarding the improvement of the symptoms, the ultrasonographic aspect of the cyst, the intraoperative findings such as hemorrhage, adhesion development and ease of dissection, and the influence of these treatments over the evolution of osteopontin and CA-125 serum markers, in patients with endometriosis. Matherial and methods: This is a retrospective study that included 300 patients diagnosed with ovarian endometriomas, for which they underwent surgery in the Department of Gynecology, Clinical Hospital „Cuza-Voda”, Iasi, in 2015 and 2016. The patients were divided in two groups: group A- patients that followed a 6 months preoperative cure with desogestrel or COCs, and group B- patients that followed a 6 months postoperative treatment with progestatives (desogestrel or dienogest), GnRH analogues (triptorelin or goserelin), or COCs. Results: Patients that were postoperative treated with GnRHa had a significantly lower level of OPN compared to those who were treated with desogestrel (p=0.001), but significantly higher compared to the average level of OPN of the patients that did not took any medication (p=0.05). According to the postoperative treatment, the average level of CA125 did not registered significant differences between the groups. The most obvious improvement regarding the clinical aspects was objectified through ultrasound examination and was seen in patients that underwent treatment with desogestrel. Also, an improvement of the intraoperative parameters, thus less damage of the remaining ovary, with a better reproductive prognosis was seen in these patients. In means of reproductive outcome, in the group of patients that underwent treatment with desogestrel or dienogest, 70% of them had become pregnant in the first year succeeding laparoscopy, compared to 67% in the COCs group and 63% in the GnRH group. Conclusions: In the present study, we tracked the evolution curve of OPN and CA125 under various hormonal medication and we observed that all these drugs have almost similar effects. However, desogestrel showed its value by offering the benefits of a well tolerated drug combined with a secure postponement of a pregnancy and a null risk of relapse.