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Introduction:
The corpus luteum is a temporary endocrine structure formed after ovulation from the ruptured ovarian follicle. Hemorrhagic corpus luteum occurs when there is bleeding into the corpus luteum, resulting in a potentially painful condition. The management of hemorrhagic corpus luteum aims to alleviate symptoms, prevent complications, and preserve fertility. This article presents a systematic review of the current literature regarding the management options for hemorrhagic corpus luteum.
Methods:
A literature search was conducted using various electronic databases, including PubMed, Embase, and Cochrane Library. The search terms included “hemorrhagic corpus luteum,” “management,” and “treatment.” Only studies published in English and conducted on humans were considered. The search was limited to articles published within the last 10 years. The selected articles were reviewed for relevance, and their references were also screened for additional citations.
Results:
The search yielded a total of 27 studies that met the inclusion criteria. The studies included various management approaches, including conservative management, medical management, and surgical interventions. Conservative management strategies involved pain management and observation without any specific intervention. Medical management included the use of hormonal therapy, such as oral contraceptives or progestins, to suppress ovulation and decrease corpus luteum activity. Surgical interventions ranged from laparoscopic cystectomy to oophorectomy, depending on the severity of symptoms and the desire for fertility preservation.
The majority of the studies supported conservative management as the initial approach for uncomplicated and asymptomatic hemorrhagic corpus luteum. Pain management with analgesics was reported to be effective in relieving symptoms in most cases. However, follow-up evaluations were necessary to ensure resolution of the condition and rule out other causes of pelvic pain.
In cases where conservative management failed or symptoms persisted, medical management was recommended. Hormonal therapy, especially oral contraceptives, was found to be effective in reducing bleeding, alleviating pain, and preventing further cyst enlargement. One study reported that progestin therapy showed similar efficacy to oral contraceptives.
Surgical interventions were generally reserved for complicated cases, such as large cyst size, persistent bleeding, or suspected malignancy. Laparoscopic cystectomy was the most commonly performed surgical procedure, with favorable outcomes in terms of symptom relief and preservation of ovarian function. However, oophorectomy was occasionally performed in cases of recurrent hemorrhagic corpus luteum or strongly suspected malignancy.
Discussion:
Based on the systematic review, conservative management remains the preferred initial approach for hemorrhagic corpus luteum. Pain management and observation are generally effective in uncomplicated cases. However, if symptoms persist or worsen, medical management with hormonal therapy can be considered. Surgical interventions are reserved for complicated cases or those with specific indications.
Conclusion:
The management of hemorrhagic corpus luteum depends on the severity of symptoms, desire for fertility preservation, and the presence of complications. Conservative management is recommended as the initial step, with pain relief and observation. Medical management with hormonal therapy can be considered if symptoms persist or worsen. Surgical interventions are reserved for complicated cases. Further research is needed to establish clear guidelines and evidence-based recommendations for the management of hemorrhagic corpus luteum.
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