ACE 2025 | Professor Li Li: Postoperative Management of Ovarian Endometriotic Cysts in Patients with Fertility Requirements

Endometriosis, a common disease affecting women's reproductive health and quality of life, has postoperative recurrence remaining a core challenge in clinical diagnosis and treatment. Studies have shown that the postoperative recurrence rate of patients with ovarian endometriotic cysts without standardized medication management can soar from 4% to 27% in the short term. However, the side effects of existing first-line drugs often lead to insufficient patient compliance, further exacerbating the recurrence risk. In response, Obstetrics and Gynecology Network invited Professor Li Li from Guangdong Women and Children's Hospital for an interview. She shared insights on key topics including the prospective cohort study on "the efficacy and safety of dydrogesterone in the postoperative management of ovarian endometriotic cysts," postoperative medication selection, and global trends in diagnosis and treatment. This interview aims to provide reference for clinical practice and promote the standardized and precise development of the field.

Obstetrics and Gynecology Network:

At the ACE 2025 Congress, you shared the prospective cohort study conducted by you and your team on "the efficacy and safety of dydrogesterone in the postoperative management of ovarian endometriotic cysts." What clinical observations or pain points initially prompted this research? What are the main challenges of postoperative recurrence of endometriosis in current clinical practice?

Professor Li Li:

The core motivation for launching this prospective cohort study is the key pain point of high postoperative recurrence risk of ovarian endometriotic cysts in clinical practice. Clinical observations have found that without effective and standardized medication management after surgery for ovarian endometriotic cysts, the patient's recurrence risk increases sharply. Studies have shown that the recurrence rate is 4% at 3 months after surgery and rises to 27% by 4 months postoperatively. This significant recurrence trend poses great challenges to patient prognosis.

Meanwhile, although evidence-based medicine has confirmed that postoperative hormonal therapy can effectively control recurrence, the currently available drugs in clinical practice still have obvious limitations. The main drugs commonly used for postoperative treatment of ovarian endometriotic cysts include progestogens, gonadotropin-releasing hormone agonists (GnRH-a), combined oral contraceptives (COCs), etc. Some of these drugs often cause various side effects, such as severe hypoestrogenic symptoms (e.g., hot flashes, night sweats), irregular bleeding, and mood disorders. These adverse reactions result in many patients being unable to adhere to long-term medication, ultimately facing the risk of recurrence. Therefore, there is an urgent clinical need for a therapeutic drug that is well-tolerated by patients for long-term use, with both efficacy and safety—this is the core driving force for initiating this study.

Based on the above clinical status, the main challenges of postoperative recurrence of endometriosis currently focus on two aspects: first, the inherent nature of the disease—when lacking standardized postoperative medication intervention, the recurrence risk rises rapidly with a high rate; second, the limitations of existing therapeutic drugs—side effects of some drugs affect patient compliance, leading to failure to complete long-term standardized treatment in some patients, thereby increasing the recurrence probability. This is also a key issue urgently needing resolution in clinical practice.

Obstetrics and Gynecology Network:

Why did this study select "dydrogesterone" as the postoperative management drug? What are its unique advantages or differentiating features compared with other commonly used drugs?

Professor Li Li:

We chose dydrogesterone as the research object based on comprehensive considerations including clinical guideline recommendations, drug characteristics, and clinical needs. Firstly, both domestic and international guidelines clearly recommend progestogens as first-line drugs for the postoperative management of ovarian endometriotic cysts, and dydrogesterone is one of the first-line progestogens recommended by guidelines, with solid evidence for clinical application.

Compared with other commonly used progestogens (such as dienogest, which is widely used in clinical practice), the unique advantages and differentiating features of dydrogesterone are mainly reflected in the following aspects:

Mild side effects and higher safety: Dydrogesterone has a low incidence of adverse reactions. Common side effects such as abnormal uterine bleeding, weight changes, and mood disorders are mild, and serious adverse events are extremely rare. This is fully consistent with the observations of our prospective cohort study, showing good patient tolerance after medication.
Non-inferior efficacy to similar drugs: Most patients included in our study had stage III or IV endometriosis, with relatively complex conditions. However, study data show that dydrogesterone is not inferior to dienogest in controlling postoperative recurrence, fully meeting the core clinical demand for efficacy in postoperative treatment.

Professor Li Li's presentation at ACE 2025 Congress

Higher patient compliance: Precisely because dydrogesterone has milder adverse reactions and causes less discomfort during medication, patients are more willing to adhere to standardized long-term use. This addresses the key clinical problem of poor patient compliance due to side effects of some drugs.
Suitable for patients with fertility needs: For endometriosis patients requiring fertility after surgery, pregnancy preparation can be initiated immediately during dydrogesterone use without waiting for drug withdrawal—this feature is particularly important. Against the backdrop of a declining population year by year from 2022 to 2024, this drug option that balances treatment and fertility needs is more in line with the goal of building a fertility-friendly society.

Based on the above core advantages, we ultimately selected dydrogesterone for the postoperative treatment of ovarian endometriotic cysts and conducted this prospective cohort study, aiming to provide a more patient-centered treatment reference for clinical postoperative management.

Obstetrics and Gynecology Network:

Through exchanges with domestic and international peers, what do you perceive as the core trends in the global field of endometriosis diagnosis and treatment?

Professor Li Li:

Through in-depth exchanges with domestic and international peers during the ACE 2025 Congress, I perceive that the core trends in the global field of endometriosis diagnosis and treatment mainly focus on the following three key aspects:

Focus on multi-dimensional exploration of pathogenesis to support new drug development: The field currently attaches great importance to population-based cohort studies. Many scholars have conducted in-depth investigations on the pathogenesis of endometriosis through genomics, metabolomics, and multi-omics integration. The core goal of these studies is to further clarify the nature of the disease, thereby providing more potential drug treatment options for patients and promoting the development of precise and personalized diagnosis and treatment methods.
Emphasis on early intervention in adolescents, covering the entire disease lifecycle: The congress set up two thematic sessions specifically discussing early screening, management, and treatment of adolescent endometriosis. This trend reminds us that endometriosis is not limited to the reproductive age but is a lifelong disease starting from adolescence, spanning the reproductive age to perimenopause. Currently, domestic scholars still have room for improvement in the diagnosis and treatment research of adolescent endometriosis, and further efforts are needed to achieve early detection and intervention, improving long-term patient prognosis.
Upgrade of diagnosis and treatment concepts, moving towards a patient-centered lifelong management model: The core global diagnosis and treatment concept has gradually shifted from single surgical treatment in the past to patient-centered lifelong management. This model emphasizes formulating personalized treatment plans based on patients' needs at different age stages; in drug selection, it no longer only focuses on efficacy but also balances safety and patient quality of life to achieve multi-dimensional balance. In addition, multidisciplinary collaboration has become an important support—by integrating resources from various disciplines, comprehensive and continuous diagnosis and treatment services are provided to patients. The prospective cohort study on dydrogesterone we conducted is precisely in line with this trend, aiming to provide patients with a postoperative management plan that is more suitable for long-term use, reduces adverse reactions, and improves quality of life.

Summary

Starting from clinical pain points, Professor Li Li clearly elaborated on the core value of dydrogesterone in the postoperative management of endometriosis. Its significant advantages in safety, efficacy, compliance, and fertility friendliness provide patients with a more demand-oriented treatment option, echoing the current global "patient-centered" lifelong management concept. Meanwhile, global trends in the field, such as multi-omics exploration of pathogenesis, early intervention in adolescents, and multidisciplinary collaboration, point out the future development direction. It is believed that with the in-depth advancement of relevant research and the continuous upgrading of diagnosis and treatment concepts, more endometriosis patients will benefit from personalized and high-quality medical services, achieving a better balance between disease management and quality of life.

Expert Profile

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Professor Li LiProfessor, Chief Physician, Medical Doctor (M.D.), Doctoral Supervisor, Postdoctoral SupervisorGuangdong Women and Children's Hospital

One of the first Batch of Distinguished Young Medical Talents in Guangdong Province;
Deputy Director of the Women and Children's Health Research Institute;
Director of the Clinical Research Management Office;
"Yangcheng Good Doctor" (2016), "China Good Doctor" (2018, 2019);
Guangzhou Women in Science and Technology Talent, Guangzhou Science Popularization Master, Expert of Yangcheng Evening News Medical Think Tank;
Vice President of the Public Health Service Branch of the Chinese Geriatrics Society;
Standing Committee Member of the Reproductive Endocrinology Committee of the Chinese Medical Education Association;
Standing Committee Member of the Reproductive Immunology Professional Committee of the Chinese Maternal and Child Health Research Association;
Vice Chairman of the Female Endocrinology Committee of the Guangdong Women Physicians Association;
Vice Chairman of the Reproductive Gynecology Professional Committee of the Guangdong Primary Medical Association;
Vice Chairman of the Women's Health Branch of the Guangdong Health Care Association;
Instructor of the National Grade IV Gynecological Endoscopy Training Base;
Principal Investigator of 17 projects including National Natural Science Foundation of China and Guangdong-Hong Kong-Macao Greater Bay Area Technological Achievement Transformation Projects; published more than 50 papers including SCI-indexed articles and 3 monographs; "Standardized Series of Minimally Invasive Treatments for Menorrhagia" won the Second Prize of Guangdong Provincial Science and Technology Progress Award and the First Prize of Guangdong Provincial Eugenic Technology Progress Jinyu Award; holder of 1 national invention patent and 1 national computer software copyright.

Editor-in-Charge: Lily