LAUSR

Study Objective To compare the efficacy of postoperative adjuvant treatment [gonadotropin-releasing hormone agonist (GnRHa) and oral contraceptives pills (OCPs)] with expectant treatment in preventing recurrent of dysmenorrhea following conservative laparoscopic surgery for deep infiltrating endometriosis (DIE) with dysmenorrhea. Design Prospective cohort study. Setting University hospital. Patients or Participants Patients who suffered from dysmenorrhea and received conservative laparoscopic surgery for DIE between January 2012 and January 2016. Interventions After conservative surgery for DIE, either postoperative adjuvant drug therapy (GnRHa or OCPs) was administered for 6 months or expectant treatment according to shared medical decision-making approach. Measurements and Main Results 147 women were found to be study eligible, 46 women were included in the GnRHa group, 42 women in the OCPs group, and 45 women in the expectant group. Based on the GEE model. The postoperative dysmenorrhea scores of all 3 groups increased gradually (Wald χ2 test, P=0.000). However, Wald χ2 test the effect of postoperative treatments and showed that VAS scores for dysmenorrhea in the GnRHa and OCPs treatment groups were significantly lower than the expectant group, but there was no difference between the GnRHa and OCPs groups. During the 24 months after surgery, 25 (18.80%) patients experienced recurrent dysmenorrhea. Kaplan-Meier analysis and log-rank test represented that the cumulative recurrence rate in expectant group (14/45) was higher than that in the hormonal groups (5/46 in the GnRHa group and 6/42 in the OCPs group) (X2=7.202, P=0.027), but this was not statistically significant between two hormonal groups (X2=0.223, P=0.637). A Cox proportional hazards model illustrated that concurrent adenomyoma, vaginal DIE and high preoperative dysmenorrhea VAS score were independent risk factors recurrent of dysmenorrhea, while postoperative medical treatment manifested positive protective effect. Conclusion Compared with expectant treatment, postoperative medical management was more effective in relieving dysmenorrheic symptoms and preventing recurrent of dysmenorrhea. This study provided guiding clinical evidence for the postoperative decision-making process for DIE.