Effect of postoperative hormonal therapy on pain following endometriosis surgery: a retrospective cohort study

BACKGROUND: Endometriosis is heterogeneous, and evidence for individualised postoperative management is limited. We assessed whether postoperative hormonal therapy exposure is associated with one-year changes in pain domains after first-time endometriosis surgery and explored factors related to treatment allocation. METHODS: = 38). For each pain domain, adjusted analysis of covariance (ANCOVA) models estimated one-year follow-up Numeric Rating Scale (NRS) differences, and therapy-group effects were tested using robust Wald omnibus tests with Holm multiplicity adjustment across domains, and post-hoc contrasts were Holm-adjusted within domains and interpreted only for domains with significant omnibus tests. HT-group membership was analysed using multinomial logistic regression. RESULTS: < 0.001). CONCLUSION: HT initiation was associated with lower one-year dysmenorrhoea/pelvic pain scores, while other domains showed no consistent differences. Younger patients were more likely to initiate or continue hormonal therapy, suggesting non-random allocation. Given the observational design and potential residual confounding, findings are hypothesis-generating and support symptom-profile-guided postoperative management; prospective studies with standardised regimens and domain-specific outcomes are needed.