Surgery: What are the pros and cons of taking hormones as well?

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PantherMedia / Cathy Yeulet

Taking after having surgery for endometriosis can possibly improve the treatment outcomes. But hormone products such as GnRH analogues often have side effects and reduce during the treatment.

Endometriosis develops when the kind of tissue that lines the womb (endometrium) starts to grow elsewhere in the abdomen. If these areas of endometriosis tissue (endometrial implants) are very painful or reduce a woman's , she may wish to have surgery.

The aim of this surgery is to remove as many endometrial implants as possible. Some specialists hope that a combination of surgery and hormone therapy could improve the chances of success. In this approach, women take hormone medication before and/or after having the surgery. The aim is to make the surgery easier and improve the outcomes.

Hormone therapy involves using a medication that suppresses the production of in the ovaries. One option is known as GnRH analogues (gonadotropin-releasing ). But these medications can have a number of side effects, including increased body hair growth, hot flashes and bone loss.

Hormonal contraceptives such as the birth control pill can be used instead of GnRH analogues. They usually contain progestins and estrogens, and are generally better tolerated than GnRH analogues are. Women are very unlikely to become pregnant during hormone therapy.

Research on hormone therapy before and after surgery

A group of scientists from the (an international research network) looked into the advantages and disadvantages of taking in addition to having surgery for endometriosis. They evaluated 25 studies in which the medication was used either

  • only before or only after surgery, or
  • both before and after surgery.

A total of about 3,400 women participated in these studies.

Research on hormone therapy before surgery

Three studies looked into hormone therapy before surgery. They compared the outcomes of this approach with the outcomes of surgery alone (without hormone therapy). Based on these studies, it's not clear whether taking before the surgery can reduce the size of endometriosis cysts. There is also hardly any data on the effects of this treatment approach on pain or (the ability to get pregnant).

Research on hormone therapy after surgery

22 studies looked into the effects of taking after surgery (over a period of about 3 to 6 months). They suggested that this treatment approach has a positive effect: It reduced the risk of the endometriosis coming back. This can also prevent pain over the longer term. It can improve too. Compared to the surgery-only group, more women who had this combined treatment became pregnant afterwards.

Table: Effectiveness of taking after surgery (after about 12 months)
  No hormone therapy Hormone therapy after surgery
In how many women did the pain return? 26 out of 100 18 out of 100
How many women were diagnosed with endometriosis again? 17 out of 100 5 out of 100
How many women got pregnant? 34 out of 100 41 out of 100

Research on hormone therapy both before and after surgery

There were no studies on the effects of taking both before and after surgery. Because of this, it's not possible to assess the pros and cons of this approach.

Side effects

Taking can lead to hot flashes, sleep problems, a dry vagina and mood swings. But most of the studies didn't look at side effects closely enough to be able to estimate how common they were. Hormone therapy also prevents women from getting pregnant for the duration of the treatment.

Chen I, Veth VB, Choudhry AJ et al. Pre- and postsurgical medical therapy for endometriosis surgery. Cochrane Database Syst Rev 2020; (11): CD003678.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on March 24, 2021
Next planned update: 2024

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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