背景和目的:口服避孕药(OCs)通常用于治疗子宫内膜异位症;关于过去是否使用OC的证据不一致,当给予无症状的女性时,对未来疾病的发展有保护作用。我们旨在评估OCs的使用与发现子宫内膜异位症的可能性之间的关系,考虑到OCs在其育龄期的时间长度。材料和方法:这是一所三级保健大学医院的单中心回顾性队列研究(人类生殖系,妇产科科,卢布尔雅那大学医学中心,斯洛文尼亚)于2012年1月至2022年12月进行。将计划进行腹腔镜手术治疗原发性不孕症并随后进行子宫内膜异位症的组织病理学诊断的生殖年龄女性与没有子宫内膜异位症诊断的女性进行比较。根据四个亚组中OC使用年限与肥沃年限的比率对它们进行分类:从不,<25%,在25%到50%之间,>50结果:总的来说,纳入1923名妇女(390名患有子宫内膜异位症和1533名无子宫内膜异位症)。子宫内膜异位症患者既往OC使用率高于对照组(72.31%vs.58.64%;p=0.001)。总的来说,既往使用OC与子宫内膜异位症的组织病理学诊断无关(aOR1.06[95%CI0.87-1.29]).未生育年龄25%使用OCs的女性患rASRMIII期子宫内膜异位症的风险降低(aOR0.50[95%CI0.26-0.95];p=0.036)或表面植入物(aOR0.88[95%CI0.58-0.95];p=0.040)。其他rASRM阶段没有检索到显著结果。使用<25%的OC,在25%到50%之间,或>50%的生育年龄没有增加患浅表子宫内膜异位症的风险,子宫内膜瘤,或死亡。结论:当OCs至少使用一次时,子宫内膜异位症的组织学诊断没有增加。当用于小于25%的育龄时,OC对表面植入物可能存在保护作用。由于与研究的局限性相关的限制,需要前瞻性研究来证实这些发现。
Background and Objectives: Oral contraceptives (OCs) are usually used to treat
endometriosis; however, the evidence is inconsistent about whether OC use in the past, when given to asymptomatic women, is protective against the development of future disease. We aimed to assess the relationship between the use of OCs and the likelihood of discovering
endometriosis, considering the length of time under OCs during their fertile age. Materials and Methods: This was a monocentric retrospective cohort study in a tertiary-care University Hospital (Department of Human Reproduction, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Slovenia) carried out from January 2012 to December 2022. Reproductive-aged women scheduled for laparoscopic surgery for primary infertility and subsequent histopathological diagnosis of endometriosis were compared to women without an
endometriosis diagnosis. They were classified based on the ratio of years of OC use to fertile years in four subgroups: never, <25%, between 25 and 50%, and >50. Results: In total, 1923 women (390 with and 1533 without
endometriosis) were included. Previous OC use was higher in those with
endometriosis than controls (72.31% vs. 58.64%; p = 0.001). Overall, previous OC usage was not related to histopathological diagnosis of endometriosis (aOR 1.06 [95% CI 0.87-1.29]). Women who used OCs for less than 25% of their fertile age had reduced risk of rASRM stage III endometriosis (aOR 0.50 [95% CI 0.26-0.95]; p = 0.036) or superficial implants (aOR 0.88 [95% CI 0.58-0.95]; p = 0.040). No significant results were retrieved for other rASRM stages. Using OCs for <25%, between 25 and 50%, or >50% of fertile age did not increase the risk of developing superficial endometriosis, endometriomas, or DIE. Conclusions: When OCs are used at least once, histological diagnoses of endometriosis are not increased. A protective effect of OCs when used for less than 25% of fertile age on superficial implants may be present. Prospective research is needed to corroborate the findings due to constraints related to the study\'s limitations.