Introduction
Medical treatment of endometriosis ranges from symptomatic control to
therapies aimed at suppressing the ovarian production of estrogen.
Almost all the treatment strategies are suppressive rather than curative
so that the discontinuation of therapy leads to recurrence of symptoms.
In 2009 a systematic review of literature estimated the recurrence rate
of endometriosis to be 21.5% and 40-50% within two and five years,
respectively(1), which is much more
prevalent than previously believed. Regrowth of residual lesions and de
novo lesion formation are possible pathogenesis mechanisms leading to
the recurrence of endometrial lesions. Radical surgery means the
elimination of all possible endometriosis implants detected in pelvic
and abdominal cavity, that is sometimes insufficient to radically remove
these lesions; therefore, lesions often reappear postoperatively.
Medical treatment options such as the application of
gonadotropin-releasing hormone agonist (GnRH-a) plays an essential role
in the management of endometriosis by reducing estrogen levels in order
to promote the progressive atrophy of an ectopic
endometrium(2).
Our objective was to introduce a less invasive and low risk management
strategy to prevent the recurrence of endometriosis through combination
therapy. In this novel management approach, GnRH-a pre-treatment is used
to reduce inflammations as well as endometriosis attachments, after
diagnosis and staging of endometriosis through laparascopy.