Ovarian endometrial cysts: the role of gonadotropin-releasing hormone agonist and/or drainage

OBJECTIVE: To evaluate the role of GnRH agonist (GnRH-a) and/or drainage in the management of large endometriomas. DESIGN: This prospective clinical study was conducted in a parallel and randomized design. SETTING: Department of Gynecology, Cliniques Universitaires St. Luc, Brussels, Belgium. PATIENTS: Eight infertile women with laparoscopically confirmed ovarian endometriotic cysts. After laparoscopic drainage of the ovarian cyst, patients were randomized. Patients in group I (n = 40) received no therapy. Patients in group II (n = 40) received GnRH-a therapy for 12 weeks. A second-look laparoscopy was performed after 12 weeks in each woman. RESULTS: After drainage, a quick recurrence of the endometrial cyst was observed in only group I. Indeed, the score and the cyst size were similar to the values observed before the first laparoscopy. In group II, a significant decrease in score and cyst diameter was observed. Ovarian biopsies revealed significant reduction in the stromal vascularization and a significant reduction in the mitotic activity in the group of women treated with GnRH-a. CONCLUSION: The quick recurrence of the ovarian cyst after drainage proved that drainage alone is ineffective. Drainage followed by GnRH-a was effective in the reduction of cyst size and the glandular mitotic activity.