Long Term Outcomes of Post-Operative Hormonal Suppression in Patients with Endometriosis: A Systematic Review and Meta-Analysis

Study Objective To determine the impact of postoperative hormonal suppression on recurrence and pain following conservative endometriosis surgery. Design Systematic review and meta-analysis of prospective observational and randomized controlled trials. Setting The following databases were searched: MEDLINE, Embase, Cochrane CENTRAL, and Web of Science from inception until October 2018. Patients or Participants Pre-menopausal women undergoing surgical treatment of endometriosis, conserving at least one ovary. Interventions Post-operative medical treatment of at least 6 months with oral contraceptive pills (OCP), levonorgesterel intra-uterine device (LNG-IUD), progestin therapy, or gonadotropin releasing hormone agonist (GnRH-a). Measurements and Main Results Post-operative hormonal suppression decreased the odds of disease recurrence (OR: 0.40; 95% CI: 0.27 – 0.60, p Hormonally suppressed patients had greater reductions in pain versus controls (SMD -0.54; 95% CI: -0.68 – -0.39, p Conclusion Post-operative hormonal suppression following conservative endometriosis surgery decreases the odds of disease recurrence and results in greater reductions in pelvic pain/dysmenorrhea compared to expectant management.