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

*Pneumothorax*

even after diaphragmatic resection [29].

prevent recurrences of catamenial pneumothorax.

ence of characteristic lesions [24, 30].

**9. Medical treatment**

Recurrence is the most common complication of CPX, and there are reported recurrence rates of 20–40% [4, 7, 41, 51]. Alifano et al. suggested that diaphragmatic resection with removal of endometrial implants is the preferred method compared to single diaphragmatic plication because plication has an disadvantage of leaving endometrial implants untreated [29, 38]. Still, recurrences may develop

Fewer recurrences after diaphragmatic coverage with a polyglactin mesh were reported by Bagan et al. To prevent recurrences, they suggested a systematic diaphragmatic covering, including the normal appearance of diaphragms, treating ocular defects, strengthening the diaphragm, and inducing adhesions to the lung [7]. There are also reports on diaphragmatic coverage with a polyglactin or polypropylene mesh [8], a polytetrafluoroethylene (PTFE) mesh [15], or a bovine pericar-

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

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 pres-

Woman's plans concerning pregnancy are very crucial, when deciding whether

(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.

to start hormonal therapy or not. In such therapies, oral contraceptive pills

dial patch [24], which has been reported with good mid-term results.

**48**

**Figure 2.**

*Accepted surgical algorithm and treatment in catamenial pneumothorax.*

There are also several medications, which are currently in use. Medical treatment is recommended in patients when catamenial pneumothorax is associated with endometriosis [17].

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 for catamenial pneumothorax.

Proven ineffectiveness of the therapy or significant side effects of the drugs are the contraindications of hormonal therapy [29].

There is an accepted surgical algorithm and treatment in catamenial pneumothorax [55], which is described in **Figure 2** in detail.
