Although surgical excision of
endometriosis both improves
pain and enhances fertility, recurrence can further exacerbate
pain and reduce fertility, which in turn impacts the quality of life and increases personal as well as social costs. Therefore, it is crucial to prevent the recurrence of symptoms and lesions after conservative surgery. This article reviews evidence regarding the prevention of postoperative recurrence of
endometriosis reported since the 1990s. Over the past 5 years, many new studies have been conducted and have demonstrated that long-term postoperative medication markedly reduces the recurrence. Most of these studies used
oral contraceptives (OC), with either the cyclic or continuous regimen, while some used oral or intrauterine
progestin. Continuous OC is more efficacious than cyclic OC, especially for
dysmenorrhea. The
levonorgestrel-releasing intrauterine system is also shown to prevent recurrence of
dysmenorrhea and possibly
endometriosis lesions.
Dienogest, a new
progestin, is shown to reduce the recurrence of
endometrioma. Similar to the case of ovarian
endometriosis, long-term postoperative medication after conservative surgery for deep infiltrating or extragenital
endometriosis seems important, although data are limited. Regardless of the lesion and the medication type, patients who discontinued medication experienced a higher incidence of recurrence, indicating that the protective effect of these medications seems to vanish rapidly after the discontinuation. On the basis of these facts, together with the pathogenesis of recurrence (
retrograde menstruation and ovulation), regular and prolonged medication until the patient wishes to conceive is highly recommended to prevent the postoperative recurrence of
endometriosis.