STUDY QUESTION Is there a difference in the use of endocrine endometriosis therapy in endometriosis patients with and without endometrioma? SUMMARY ANSWER Patients with endometriomas received significantly less endocrine endometriosis treatment (present intake in 42.5%) compared to patients with other forms of endometriosis and without endometriomas (present intake in 52.1%). WHAT IS KNOWN ALREADY Endocrine endometriosis therapy in patients with endometriomas reduces the risk of recurrence and therefore the risk of further surgery and subsequent irreversible damage to ovaries which results into reduced antral follicle counts (AFC), anti-Mullerian hormone levels (AMH), and early menopause. However, there is evidence of increasing rejection of endocrine endometriosis treatment in this population. STUDY DESIGN, SIZE, DURATION A total of 838 premenopausal woman with dysmenorrhea and/or endometriosis (mean age 30.7 ± 6.9 years, range 15–54 years) were included in this observational cross-sectional multicenter study. Data including the extent of dysmenorrhea, prevalence of other comorbidities like migraine with aura and migraine never with aura, diagnosis of endometriosis, history of endometriosis surgery, and hormone therapy, were collected in a retrospective online survey from May to November 2023. PARTICIPANTS/MATERIALS, SETTING, METHODS Patients visiting two university hospital endometriosis centers between January 2017 and March 2023, and with available email address, were invited for study participation by email in May 2023. Further recruitment of participants was achieved through the website and social medial channels of the German Endometriosis Association. Participation in the online survey was open between May and November 2023. MAIN RESULTS AND THE ROLE OF CHANCE In the subgroup of women (with dysmenorrhea) without surgically confirmed endometriosis (SCE) (n = 277), 95 (34.3%) were currently undergoing endocrine treatment for dysmenorrhea and contraceptional purposes. On the contrary, in the subgroup of patients with SCE (n = 561), 275 (49.0%) were currently undergoing hormonal treatment. Subjects with SCE therefore significantly more commonly took endocrine treatment (F = 16.587, P < 0.001) compared to those without SCE. Endometriomas were present in 254 patients (45.2% of all SCE patients), and these patients were significantly less likely to have used hormonal treatment (i) in the present and (ii) in the past (i. n = 113 42.5%, ii. n = 187, 73.9%) compared to patients with other forms of endometriosis (n = 261) (i. n = 139, 52.1%, ii. n = 220, 84.3%) (i. F = 3.976, P = 0.047, ii. F = 8.297, P = 0.004). Various reasons for rejection of endocrine endometriosis treatment were analyzed, when comparing endometrioma subjects to patients with other types of endometriosis, but no statistical differences were found. LIMITATIONS, REASONS FOR CAUTION This study is limited by its retrospective design and an online questionnaire with patient-reported outcomes. A selection bias due to the voluntary nature of the study and the online recruitment is also possible. WIDER IMPLICATIONS OF THE FINDINGS The results show that patients often refuse endocrine endometriosis treatments without a rational medical reason. According to the literature, this unnecessarily exposes these patients to a higher risk for endometrioma recurrence and subsequently a higher risk of repeat surgery and permanent damage to ovarian function. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the University of Luebeck (budget for university teaching and research). A.C. was supported by DFG (CRC/TR 296 ‘Local control of TH action’, LocoTact, P07) and by funds of University of Luebeck, medical section (LACS01-2024). N.B. was supported by the DFG (BR4328.2-1, GRK1957), the Michael J Fox Foundation, the Collaborative Center for X-linked Dystonia-Parkinsonism and the EU Joint Programme—Neurodegenerative Disease Research (JPND). C.C., H.G., C.G., I.A., A.K., A.R. received no funding for this study. There were no competing interests. TRIAL REGISTRATION NUMBER N/A.

中文翻译：

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子宫内膜异位症患者未得到内分泌子宫内膜异位症治疗的治疗


研究问题 子宫内分泌子宫内膜异位症治疗在子宫内膜异位症患者和不伴有子宫内膜异位症患者中的使用是否有差异？摘要 答案 与其他形式的子宫内膜异位症患者和无子宫内膜异位症的患者（目前摄入量为 52.1%）相比，子宫内膜异位症患者接受的内分泌子宫内膜异位症治疗（目前摄入量为 42.5%）显着减少。已知的子宫内膜异位症患者内分泌子宫内膜异位症治疗可降低复发风险，从而降低进一步手术和随后对卵巢造成不可逆损伤的风险，从而导致窦卵泡计数 （AFC）、抗苗勒管激素水平 （AMH） 降低和更年期提前。然而，有证据表明该人群对内分泌子宫内膜异位症治疗的排斥反应增加。研究设计、规模、持续时间 这项观察性横断面多中心研究共纳入 838 名患有痛经和/或子宫内膜异位症的绝经前妇女 （平均年龄 30.7 ± 6.9 岁，范围 15-54 岁）。在 2023 年 5 月至 11 月的一项回顾性在线调查中收集了包括痛经程度、其他合并症（如有先兆偏头痛和从未有先兆偏头痛）的患病率、子宫内膜异位症的诊断、子宫内膜异位症手术史和激素治疗在内的数据。参与者/材料、设置、方法 2017 年 1 月至 2023 年 3 月期间访问两所大学医院子宫内膜异位症中心的患者，并拥有可用的电子邮件地址，于 2023 年 5 月通过电子邮件邀请参加研究。通过德国子宫内膜异位症协会的网站和社交媒体渠道进一步招募了参与者。在线调查的参与时间为 2023 年 5 月至 11 月。 主要结果和机会的作用 在未手术证实子宫内膜异位症 （SCE） 的女性 （痛经） 亚组 （n = 277） 中，95 名 （34.3%） 目前正在接受痛经和避孕目的的内分泌治疗。相反，在 SCE 患者亚组 （n = 561） 中，275 名 （49.0%） 目前正在接受激素治疗。因此，与没有 SCE 的患者相比，患有 SCE 的受试者明显更常接受内分泌治疗 （F = 16.587，P < 0.001）。子宫内膜异位症见于 254 名患者（占所有 SCE 患者的 45.2%），这些患者 （i） 现在和 （ii） 过去 （i. n = 113 42.5%， ii. n = 187， 73.9%） 与其他形式的子宫内膜异位症患者 （n = 261） （i. n = 139， 52.1%， ii. n = 220， 84.3%） （i. F = 3.976， P = 0.047， ii.F = 8.297，P = 0.004）。将子宫内膜异位症受试者与其他类型子宫内膜异位症患者进行比较时，分析了内分泌子宫内膜异位症治疗排斥反应的各种原因，但未发现统计学差异。局限性，谨慎的原因 本研究受到其回顾性设计和包含患者报告结果的在线问卷的限制。由于研究和在线招募的自愿性质，也可能出现选择偏倚。研究结果的更广泛意义 结果表明，患者经常在没有合理医学理由的情况下拒绝内分泌子宫内膜异位症治疗。根据文献，这不必要地使这些患者面临更高的子宫内膜异位症复发风险，从而增加重复手术和卵巢功能永久性损伤的风险。 研究资金/利益争夺 本研究由吕贝克大学（大学教学和研究预算）资助。A.C. 得到了 DFG（CRC/TR 296“TH 作用的本地控制”，LocoTact，P07）和吕贝克大学医学科基金 （LACS01-2024） 的支持。NB 得到了 DFG （BR4328.2-1， GRK1957）、Michael J Fox 基金会、X 连锁肌张力障碍-帕金森病合作中心和欧盟联合计划-神经退行性疾病研究 （JPND） 的支持。C.C.， H.G.， C.G.， I.A.， A.K.， A.R. 没有获得这项研究的资助。没有相互竞争的利益。试验注册号 N/A。