Department of Obstetrics and Gynecology (Drs. Thiel, Kobylianskii, and Murji), Mount Sinai Hospital, Toronto, ON, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada (Drs. Thiel, Kobylianskii, and Murji).
Department of Obstetrics, Gynecology, and Reproduction, Université Laval, Quebec City, QC, Canada (Drs. Donders and Maheux-Lacroix).
J Minim Invasive Gynecol. 2024 Apr;31(4):273-279. doi: 10.1016/j.jmig.2024.01.002. Epub 2024 Jan 6.
To evaluate the effect of hormonal suppression of endometriosis on the size of endometriotic ovarian cysts.
The authors searched MEDLINE, PubMed, Cochrane Central Register of Controlled Trials, Embase, and ClinicalTrials.gov from January 2012 to December 2022.
We included studies of premenopausal women undergoing hormonal treatment of endometriosis for ≥3 months. The authors excluded studies involving surgical intervention in the follow-up period and those using hormones to prevent endometrioma recurrence after endometriosis surgery. Risk of bias was assessed with the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool. The protocol was registered in PROSPERO (CRD42022385612).
TABULATION, INTEGRATION, AND RESULTS: The primary outcome was the mean change in endometrioma volume, expressed as a percentage, from baseline to at least 6 months. Secondary outcomes were the change in volume at 3 months and analyses by class of hormonal therapy. The authors included 16 studies (15 cohort studies, 1 randomized controlled trial) of 888 patients treated with dienogest (7 studies), other progestins (4), combined hormonal contraceptives (2), and other suppressive therapy (3). Globally, the decrease in endometrioma volume became statistically significant at 6 months with a mean reduction of 55% (95% confidence interval, -40 to -71; 18 treatment groups; 730 patients; p <.001; I = 96%). The reduction was the greatest with dienogest and norethindrone acetate plus letrozole, followed by relugolix and leuprolide acetate. The volume reduction was not statistically significant with combined hormonal contraceptives or other progestins. There was high heterogeneity, and studies were at risk of selection bias.
Hormonal suppression can substantially reduce endometrioma size, but there is uncertainty in the exact reduction patients may experience.
评估子宫内膜异位症的激素抑制对子宫内膜异位症卵巢囊肿大小的影响。
作者检索了 2012 年 1 月至 2022 年 12 月期间的 MEDLINE、PubMed、Cochrane 对照试验中心注册库、Embase 和 ClinicalTrials.gov。
纳入了接受激素治疗子宫内膜异位症≥3 个月的绝经前妇女的研究。作者排除了随访期间接受手术干预的研究和使用激素预防子宫内膜异位症手术后子宫内膜瘤复发的研究。使用纽卡斯尔-渥太华量表和 Cochrane 偏倚风险工具评估偏倚风险。该方案在 PROSPERO（CRD42022385612）中进行了注册。
列表、整合和结果：主要结局是从基线到至少 6 个月时子宫内膜瘤体积的平均变化，以百分比表示。次要结局是 3 个月时的体积变化以及按激素治疗类别进行的分析。作者纳入了 16 项研究（15 项队列研究，1 项随机对照试验），共 888 例接受地诺孕素（7 项研究）、其他孕激素（4 项）、复方激素避孕药（2 项）和其他抑制性治疗（3 项）的患者。总体而言，6 个月时子宫内膜瘤体积的下降具有统计学意义，平均减少 55%（95%置信区间，-40 至-71；18 个治疗组；730 例患者；p<0.001；I=96%）。地诺孕素和醋酸炔诺酮加来曲唑的减少幅度最大，其次是瑞卢戈利和亮丙瑞林。复方激素避孕药或其他孕激素的体积减少无统计学意义。存在高度异质性，且研究存在选择偏倚风险。
激素抑制可以显著减小子宫内膜瘤的大小，但患者可能经历的确切减少程度存在不确定性。
