Dienogest compared with gonadotropin‐releasing hormone agonist after conservative surgery for endometriosis

Abstract

Aim: Although there are various hormone therapies, including gonadotropin-releasing hormone agonist, danazol, levonorgestrel-releasing intrauterine system, dienogest, and low-dose estrogen progestin, no consensus opinion has been reached in terms of which medication should be used and for how long it should be administered. We aimed to determine whether dienogest or goserelin is the better postoperative therapy to prevent recurrence of endometriosis. Methods: A prospective cohort randomized study were conducted, including 198 patients diagnosed as having endometriosis. A total of 111 patients were randomly assigned into two groups: the dienogest-administered group (n = 56) and the goserelin-administered group (n = 55). Patients were followed for 24 months after laparoscopic surgery. Those who gave consent but desired no postoperative therapy were assigned to the non-treatment group (n = 79). Recurrence, side-effects, degrees of menstrual pain and chronic pelvic pain measured by the Visual Analogue Scale were compared among the three groups: the dienogest, goserelin, and non-treatment groups. Results: No significant difference was observed in the postoperative recurrence rate between the dienogest and goserelin groups. No significant difference was found in the recurrence rate between the goserelin group and nontreatment group; however, a significant difference was found in the recurrence rate between the dienogest group and the non-treatment group (P = 0.027). Menstrual pain and chronic pelvic pain were significantly improved in both treatment groups. Side-effects were markedly observed in the goserelin group as compared with the dienogest group. Conclusion: Dienogest is available for prolonged administration of more than 6 months, so it is more useful than goserelin, which is available only for short-term administration.

A comparison of reproductive outcomes of patients with adenomyosis and infertility treated with High-Intensity focused ultrasound and laparoscopic excision

“…Gonadotropinreleasing hormone agonist (GnRHa), which has been proven to increase pregnancy rates in patients with adenomyosis, has been widely used [25]. However, the high recurrence rate and the adverse effects of GnRHa renders limit its applicability [26]. Classical surgical management of adenomyosis, including laparoscopic adenomyosis lesion excision, is associated with a high uterine rupture risk and relatively long recovery time [27].…”

Use of dienogest in endometriosis: a narrative literature review and expert commentary

“…Even after successful surgery, recurrence of endometriosis-associated symptoms is frequently observed 79,80 , and prescription of medical treatment for the long-term prevention of recurrence is recommended 2 . Several studies support the use of long-term dienogest for the prevention of recurrence 29,30,33,[81][82][83][84][85][86][87] , and a reduction in recurrent endometrioma size 30 has been observed for up to 5 years following surgery (Table 3) 29,30,33,[81][82][83][84][85] . In a retrospective cohort study of 568 women with endometrioma, cumulative disease recurrence rates 5 years postsurgery were 69% in women receiving no medical treatment, compared with 4% in women taking dienogest 2 mg 81 .…”

“…Asymptomatic ovarian endometriomas should be monitored but do not require medical or surgical treatment; if the endometrioma is large and there is a risk of rupture, then surgery should be considered Surgery should be considered in cases of atypical findings via ultrasound examination Painful ovarian cysts >3-4 cm in diameter should be treated surgically, in line with treatment guidelines 2 Medical treatments can be prescribed for symptomatic relief when awaiting surgery Medical treatments, including dienogest 2 mg, should be prescribed postsurgery to prevent the recurrence of endometriosis, unless there is an immediate desire for pregnancy. Postoperative dienogest 2 mg treatment has been effective in the prevention of endometriosis symptom recurrence and endometrioma 29,30,33,[81][82][83][84][85][86] Long-term treatment with dienogest 2 mg has been shown to decrease recurrent endometrioma size, which may indicate an additional benefit of its use in medical treatment 30…”

Dienogest versus gonadotropin-releasing hormone analogue for the clinical treatment of endometriosis: a systematic review and meta-analysis

“…We summarized and tabulated the extracted data from the included studies (Attachment 1). Two studies (Takaesu, 2016 andCosson, 2002) administered the medications and followed the patients after laparoscopic surgery. The other studies (Harada, 2009 (Figure 1).…”