Design: Retrospective cohort study

Setting: Patients 18-51 years who enrolled in the Penn Medicine BioBank from 2008-2023.

Patients or Participants: Patients with surgically confirmed endometriosis were included. Patients were excluded if endometriosis was diagnosed at cesarean section, surgery for gynecologic malignancy, or non-abdominal surgery.

Interventions: Patients were divided into four groups: pre-operative hormone use (pre), post-operative hormone use (post), pre- and post-operative hormone use (pre+post) , and no hormone use (none). The primary outcome was pain-free interval (time between index surgery and re-presentation). Differences in pain-free interval by hormonal suppression group were determined using Cox regression analysis, adjusting for relevant covariates.

Measurements and Main Results: 164 patients were included: 29 (pre), 25 (post), 29 (pre+post), and 81 (none). Groups were similar in BMI and genetic ancestry, though patients with (pre+post) were younger (age 27 vs 38 (none), 38 (pre), and 33(post) p<0.001), and were less likely to undergo hysterectomy as index surgery (6.8% vs. 35.8% (none), 44.8% (pre), and 16.0% (post) p<0.01). AAGL score was highest in the (post) group (median 19 vs 8 (pre), 8 (pre+post), and 10 (none), p<0.002). Recurrence incidence was similar across groups: pelvic pain (43.21% (none), 44.83% (pre), 60.0% (post), 68.97% (pre+post) p=0.07) ; next surgery (17.2% (none), 17.2% (pre), 32.0% (post), 31.03% (both) p=0.23). Shorter time to recurrence of pain was noted in the (pre+post) (HR 2.05 [1.16-3.63]); however, there was no difference in adjusted models (aHR 1.35 [0.72-2.52]).

Conclusion: Peri-operative hormone use was not associated with a longer symptom-free interval after surgery for endometriosis after adjusting for surgical complexity.