**9. Medical treatment**

Hormonal treatment has a supplementary role in the treatment of catamenial pneumothorax. With the administration of hormonal therapy, it is possible to prevent recurrences of catamenial pneumothorax.

A multidisciplinary approach is mandatory for the management of the disease and administration of gonadotrophin-releasing hormone (GnRH) analogue, which results in the lack of menses, and is suggested for all patients with proven catamenial pneumothorax in the early postoperative period for 6–12 months [4, 7, 8, 22, 24, 30, 48]. Patients without documented catamenial character or histologically proven thoracic endometriosis may also benefit from hormonal treatment even in the presence of characteristic lesions [24, 30].

Woman's plans concerning pregnancy are very crucial, when deciding whether to start hormonal therapy or not. In such therapies, oral contraceptive pills (estrogen-progestogen) are usually used which induce menses every 28 days or they are used continuously without inducing menses. These pills also include progestogens, and they may be administered orally, intramuscularly, or in intrauterine way.

**49**

*Catamenial Pneumothorax*

endometriosis [17].

for catamenial pneumothorax.

**10. Results of treatment**

mothorax [8–10, 22–24, 29].

recurrence [24, 30, 38–56].

**11. Conclusions**

the surgical results.

*DOI: http://dx.doi.org/10.5772/intechopen.82564*

the contraindications of hormonal therapy [29].

thorax [55], which is described in **Figure 2** in detail.

reported recurrence rates of 20–40% [4, 7, 41, 53].

routine postoperative hormonal treatment [55].

when recurrent catamenial pneumothorax occurs.

fenestrations are detected in diaphragm.

pneumothorax [3–13, 15, 23, 24, 30, 32].

There are also several medications, which are currently in use. Medical treatment is recommended in patients when catamenial pneumothorax is associated with

The aim of early GnRH analogue delivery is to prevent cyclic hormonal changes and to suppress the activity of the ectopic endometrium until effective pleurodesis occurs, because time is needed for the formation of effective pleural adhesions [38]. Hormonal treatment is advised for longer periods especially after reoperations

Proven ineffectiveness of the therapy or significant side effects of the drugs are

There is an accepted surgical algorithm and treatment in catamenial pneumo-

Practically, surgery for catamenial pneumothorax has very low mortality and morbidity. Recurrence is the most common complication of CPX, and there are

High recurrence rates are much higher than surgically treated idiopathic pneu-

A low recurrence rate (8.3%), at a mean follow-up of 45.8 months, was reported by Attaran et al., by video thoracoscopic abrasion and pleurectomy, diaphragmatic repair and PTFE mesh coverage for the repair of diaphragmatic defects, and a

Also Alifano et al. reported that the highest postoperative recurrence rate in 114 women who were operated due to recurrent spontaneous pneumothorax was in the catamenial pneumothorax group (32%), and this was followed by a noncatamenial endometriosis-associated pneumothorax group (27%). They also reported a recurrence rate of 5.3%, at a mean of 32.7 months of follow-up, in patients with noncatamenial nonendometriosis-associated pneumothorax [32]. Incomplete surgical treatment of lesions and lack of additional hormonal treatment in the early postoperative period [23, 24, 38–54] may increase the risk of

Young women with pneumothorax, especially in the perimenstrual period, should be suspected of catamenial pneumothorax. Failure occurs most frequently

The lesions of the parietal and visceral pleura should be carefully examined and removed during surgery. Diaphragm reconstruction is required every time when

Hormonal therapy is also recommended because it facilitates the effectiveness of

Multidisciplinary approach with early postoperative hormonal treatment, which

deals with all thoracic pathologies including disease awareness, early diagnosis, diaphragmatic repair, and surgical management of the main chronic systemic disease, may eventually lead to a reduction in the rate of recurrence of catamenial

Treatment of women of childbearing age is different from men of the same age group. CPX should be excluded in the cohort of women, especially when the

### **Figure 2.** *Accepted surgical algorithm and treatment in catamenial pneumothorax.*
