The Efficacy of Medical Treatment on Endometrioma: A Systematic Review and Meta-Analysis

Abstract

Background: Ovarian endometriomas have been shown to have a negative effect on fertility. There is a dilemma on the timing for surgery either before or after the fertility treatment. By delaying surgical treatment for infertile patients with endometriomas, medical treatment has become an important choice for these patients. The objectives of this review were to compare the efficacy of medical treatment on endometrioma size and endometriosis-associated pelvic pain (EAPP). Methods: We performed a systematic review and meta-analysis examining women who have endometrioma and underwent medical therapy for endometrioma size reduction. The primary outcome measure was endometrioma size reduction. Secondary outcome measures EAPP. Results: We included 14 studies for the meta-analysis. We performed a systematic review and meta-analysis examining women with endometrioma who underwent medical therapy for endometrioma size reduction. The primary outcome measure was endometrioma size reduction. Secondary outcome measure is EAPP. The majority of the studies were non-randomized controlled trials (RCTs; 9/14), and five were RCTs. Women who received medical treatment have a significant endometrioma size reduction in diameter compared to women not receiving any medical treatment or placebo (MD −9.66[Formula: see text]mm; 95% CI [−13.85, −5.46], three studies, 467 women, [Formula: see text]%) and a reduction in visual analog scale (VAS) for EAPP (MD −2.64; 95% CI [−3.31, −1.97], two studies, 338 women, [Formula: see text]%). Women who received dienogest (DNG) treatment have a significant endometrioma size reduction in diameter (MD −4.61[Formula: see text]mm; 95% CI [−9.08, −0.15], three studies, 220 women, [Formula: see text]%). Compared to women receiving other medical treatments, women receiving DNG treatment had more VAS reduction of EAPP (MD −0.46; 95% CI [−0.62, −0.31], four studies, 451 women, [Formula: see text]%). Conclusions: The use of medical therapy is associated with endometrioma size reduction and a reduction in endometriosis-related pain when compared with no medical treatment given. With the availability of various medical options, surgery can thus be avoided to minimize the risk of damage to the ovarian reserves.