子宮內膜異位瘤手術可能提早更年期

切除卵巢子宮內膜異位瘤之病患可能會面臨提早更年期之風險
切除宮內膜異位瘤電燒過程可能會對於卵巢造成潛在損傷

http://humrep.oxfordjournals.org/content/26/11/3000.full

Ovarian surgery for bilateral endometriomas influences age at menopause

1. Maria Elisabetta Coccia1,*, 
2. Francesca Rizzello2, 
3. Giulia Mariani1,
4. Carlo Bulletti3, 
5. Antonio Palagiano4 and 
6. Gianfranco Scarselli1

+Author Affiliations

1. ¹Department of Science for the Health of Woman and Child, University of Florence, Via Ippolito Nievo 2, 50129 Florence, Italy
2. ²Department of Experimental Medicine, Section of Medical Physiopathology, University of Rome ‘La Sapienza’, Rome, Italy
3. ³Unit of Physiopathology of Reproduction, Cattolica General Hospital and University of Bologna, Bologna, Italy
4. ⁴Department of Obstetrics, Gynecology, and Reproductive Sciences, Second University of Naples, Naples, Italy

1. ↵*Correspondence address. Tel: +39-335-6346293; Fax: +39-055-88431171; E-mail: cocciame@tin.it

• Received April 13, 2011.
• Revision received July 22, 2011.
• Accepted August 3, 2011.

 

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Abstract

BACKGROUND Questions remain as to whether surgical excision of ovarian endometriomas might cause damage to ovarian function. To test the hypothesis that ovarian surgery for endometrioma compromises ovarian function and accelerates ovarian failure.

METHODS In a tertiary university Clinic, longitudinal prospective cohort study. Patients who underwent laparoscopy for endometriosis between March 1993 and November 2007 were assessed for inclusion in the study. A prospective follow-up at 3, 6 and 12 months then yearly was conducted. Evolution of menstrual pattern, symptoms and reproductive outcomes were investigated.

RESULTS From over the 14-year period, 302 patients were included in the study. The mean age (±SD) of patients was 32.6 ± 5.6 years; the median duration of follow-up was 8.5 years (range 2–17 years). Menopause was documented in 43 women (14.3%) at a mean age of 45.3 ± 4.3 years (range 32–52 years). Women previously submitted to bilateral cystectomy were younger at menopause than those with monolateral endometrioma (42.1 ± 5.1 years versus 47.1 ± 3.5 years, P = 0.003). Premature ovarian failure (POF) was observed in 7 of 43 (16.3%) menopausal patients; the majority (4, 57.1%) after bilateral cystectomy. The relationship between the preoperative ovarian endometriomas total diameter and menopausal age was significant in case of surgery for bilateral endometriomas (R² = 0.754, P = 0.002).

CONCLUSIONS Patients who had been operated on for bilateral endometriomas have an increased risk of POF. Ovarian parenchyma loss at the time of surgery seems related to cyst diameter. In the case of unilateral ovarian endometrioma, the contralateral intact ovary might adequately compensate.

Figure 1

Chart showing the age of menopause onset for patients who do not receive any ovarian surgery, after surgery for monolateral ovarian endometrioma, after surgery for bilateral ovarian endometriomas. Mean age at menopause is shown (the mid-circles) and error bars represent the 95% confidence intervals (CIs). Data show a significantly younger age at menopause in the group submitted to surgery for bilateral ovarian endometriomas when compared with menopausal age after surgery for monolateral endometrioma (Mean menopausal age 42.1 ± 5.1 years in ‘bilateral endometriomas group’ versus 45.1 ± 3 years in ‘no ovarian surgery group’ and 47.1 ± 3.5 years in ‘monolateral endometrioma group’). Student t-test: ‘Bilateral endometriomas group’ versus ‘no ovarian surgery group’: P = 0.117; ‘Bilateral endometriomas group’ versus ‘monolateral endometrioma group’: P = 0.003; ‘Monolateral endometrioma group’ versus ‘no ovarian surgery group’: P = 0.102.