Pre or post-operative medical treatment with nafarelin in stage III-IV endometriosis: a French multicenter study.

OBJECTIVES

To determine the effectiveness of a 6-month course of nafarelin in the treatment of stage III-IV endometriosis and to determine if pre-operative use of nafarelin facilitates surgery.

DESIGN

Prospective, multicenter, clinical trial.

SETTING

Eight university hospitals and two private practice institutions in France.

PATIENTS

Fifty-five patients with stage III and IV endometriosis. Two were excluded.

INTERVENTIONS

The severity of endometriosis was assessed at the time of laparoscopy and patients were randomized to have either laparosopic surgery at that time following 6 months of nafarelin therapy (n=28), or laparoscopic surgery following 6 months of nafarelin therapy (n=25). All had 200 microg intranasal nafarelin twice a day for 6 months and a second look laparoscopy.

MAIN OUTCOME MEASURE

Clinical efficacy, tolerance to the treatment.

RESULTS

Efficacy and tolerance to the treatment were the same in both groups. AFS scores compared on both laparoscopies were significantly better if nafarelin was given prior to surgery (P=0.007).

CONCLUSIONS

This preliminary study shows that in cases of combined medico-surgical treatment for stage III-IV endometriosis, preoperative medical treatment with GnRH-a gives a better AFS score improvement, but no conclusion was possible whether preoperative treatment facilitates surgery.