The use of GnRH agonists in deep endometriosis after conservative surgery - case report

R. Cigaran, L. Mustaţă, A.M. Panaitescu, G. Peltecu, N. Gică

Rezumat: Severe endometriosis requires complex surgical and medical treatment to suppress the symptoms that may affect the quality of life of patients with this pathology. We report a case of stage IV endometriosis treated with gonadotropin-releasing hormone (GnRH) agonist after conservative surgery. An 18-year-old nulliparous woman was admitted in our clinic with a history of severe chronic pelvic pain, dysmenorrhea, dyspareunia and dysuria. After a clinical, biological, transvaginal ultrasonography and pelvic CT examination, we diagnosed an rectovaginal endometriosis and bilateral ovarian endometriotic cyst. During laparotomy, a stage IV pelvic endometriosis was found, with bilateral endometrioma of the ovaries, multiple adhesions, deep and superficial lesions of endometriosis. An extensive adhesiolysis, left oophorectomy, right cystectomy and partial omentectomy were performed. For the next 1.5 years, the patient was treated with GnRH for 3 months (goserelin acetate 3.6 mg/month) and then with continuous oral progestin therapy. After 1.5 years, the patient remained asymptomatic, the treatment improving the quality of life. In selected cases, GnRH agonists remains an effective treatment for recurrent symptoms of endometriosis, especially if administered early after surgical therapy.
Cuvinte cheie: endometriosis, GnRH agonists, surgical conservative treatment.