Dienogest therapy during the early stages of recurrence of endometrioma might be an alternative therapeutic option to avoid repeat surgeries

Koshiba, Akemi; Mori, Taisuke; Okimura, Hiroyuki; Kataoka, Hideki; Takahashi, Osamu; Ito, Fumihiko; Miyata, Hiroshi; Izumi, Kouji; Kitawaki, Jo

doi:10.1111/jog.13725

Cited by 27 publications

(26 citation statements)

References 26 publications

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“…Additionally, Harada et al suggest that dienogest can be a new conservative approach for extragenital endometriosis-related pain and in particular for rectosigmoidal and bladder endometriosis [ 63 ]. Noteworthy, evidence exists in favour of postoperative treatment with dienogest aiming to prevention of recurrence and pain relief, while administrated immediately after recurrence and for long-term use, dienogest is a better option than GnRH analogues [ 64 , 65 ]. Last but not least, dienogest might help in maintaining fertility in patients with endometriosis by avoiding the damage of repeat surgeries to ovarian reserve [ 64 ].…”

Section: Gastrointestinal Tract Endometriosismentioning

confidence: 99%

Gastrointestinal and Urinary Tract Endometriosis: A Review on the Commonest Locations of Extrapelvic Endometriosis

Charatsi

Koukoura

Ntavela

et al. 2018

Advances in Medicine

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Extrapelvic endometriosis is a rare entity that presents serious challenges to researchers and clinicians. Endometriotic lesions have been reported in every part of the female human body and in some instances in males. Organs that are close to the uterus are more often affected than distant locations. Extrapelvic endometriosis affects a slightly older population of women than pelvic endometriosis. This might lead to the assumption that it takes several years for pelvic endometriosis to “metastasize” outside the pelvis. All current theories of the pathophysiology of endometriosis apply to some extent to the different types of extrapelvic endometriosis. The gastrointestinal tract is the most common location of extrapelvic endometriosis with the urinary system being the second one. However, since sigmoid colon, rectum, and bladder are pelvic organs, extragenital pelvic endometriosis may be a more suitable definition for endometriotic implants related to these organs than extrapelvic endometriosis. The sigmoid colon is the most commonly involved, followed by the rectum, ileum, appendix, and caecum. Most lesions are confined in the serosal layer; however, deeper lesion can alter bowel function and cause symptoms. Bladder and ureteral involvement are the most common sites concerning the urinary system. Unfortunately, ureteral endometriosis is often asymptomatic leading to silent obstructive uropathy and renal failure. Surgical excision of the endometriotic tissue is the ideal treatment for all types of extrapelvic endometriosis. Adjunctive treatment might be useful in selected cases.

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Section: Gastrointestinal Tract Endometriosismentioning

confidence: 99%

Gastrointestinal and Urinary Tract Endometriosis: A Review on the Commonest Locations of Extrapelvic Endometriosis

Charatsi

Koukoura

Ntavela

et al. 2018

Advances in Medicine

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“…Among the 18 cohorts 18,29,37–52 ( n = 3316), mean age ranged from 27.3 to 37.9 years. Most studies (61.1%) enrolled patients with moderate‐to‐severe disease.…”

Section: Resultsmentioning

confidence: 99%

“…Data from the 16 cohorts 18,37,38,[40][41][42][43][44][45][46][47][48][49][50][51][52] (n = 3089) were pooled in NMA of eight regimens (i.e. expectant management, cyclic OC, continuous OC, GnRHa, DNG, LNG-IUS, GnRHa + OC and GnRHa + LNG-IUS) ( Figure S9).…”

Section: Cohortsmentioning

confidence: 99%

“…Six, [30][31][32][33]35,36 four, 30,34-36 two 34,36 and one 36 RCT, respectively, reported endometrioma recurrence, dysmenorrhoea/ pelvic pain recurrence, AEs and time to event outcome (Figure 1). Among the 18 cohorts 18,29,[37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52] (n = 3316), mean age ranged from 27.3 to 37.9 years. Most studies (61.1%) enrolled patients with moderate-to-severe disease.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

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Postoperative hormonal treatment for prevention of endometrioma recurrence after ovarian cystectomy: a systematic review and network meta‐analysis

Wattanayingcharoenchai

Rattanasiri

Charakorn

et al. 2020

BJOG

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Background The efficacy of hormonal regimens for the prevention of endometrioma recurrence in women who have undergone conservative surgery is still controversial. Objective To compare the efficacy of different hormonal regimens in this context and to rank them. Search strategy MEDLINE and Scopus databases were searched through January 2020. Selection criteria Randomised controlled trials (RCTs) or cohorts, comparing the effect of any pair of interventions (i.e. cyclic oral contraceptives [OC], continuous OC, gonadotropin-releasing hormone agonist [GnRHa], dienogest [DNG], levonorgestrelreleasing intrauterine system [LNG-IUS] and expectant management) on endometrioma recurrence were selected. Data collection and analysis Data were independently extracted by two reviewers. Relative treatment effects were estimated using network meta-analysis (NMA) and ranked in descending order. Main results Six RCTs (675 patients) and 16 cohorts (3089 patients) were included. NMA of the RCTs involving expectant management, cyclic OC, continuous OC, GnRHa and GnRHa + LNG-IUS, showed that all hormonal regimens had a nonsignificant lower risk of endometrioma recurrence compared with expectant management. NMA of the cohorts involving expectant, cyclic OC, continuous OC, GnRHa, DNG, LNG-IUS, GnRHa + OC, and GnRHa + LNG-IUS indicated that LNG-IUS, DNG, continuous OC, GnRHa + OC and cyclic OC had a significantly lower risk of endometrioma recurrence than expectant management. LNG-IUS was ranked highest, followed by DNG and GnRHa + LNG-IUS. Long-term use of hormonal treatment either OC or progestin had a significantly lower risk of endometrioma recurrence than expectant treatment. Conclusion In the NMA of RCTs, there was no evidence supporting hormonal treatment for postoperative prevention of endometrioma recurrence. This was at odds with the cohort evidence, which found the protective effect of OC and progestin regimens, especially long-term treatment. Large-scale RCTs of these agents are still required.

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“…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 .…”

Section: Preventing Postsurgical Recurrence Of Endometriosismentioning

confidence: 94%

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

Murji

Biberoğlu²,

Leng

et al. 2020

Current Medical Research and Opinion

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Objective: Endometriosis affects up to 10% of women of reproductive age, and the main goal of treatment is to relieve symptoms. Progestins have been the mainstay of endometriosis suppression, of which dienogest has become an important option in many parts of the world. This is an expert literature review, with recommendations on the use of dienogest in the context of various clinical considerations when treating endometriosis. Methods: A search of PubMed was conducted for papers published between 2007 and 2019 on the use of dienogest in endometriosis. Experts reviewed these and included those they considered most relevant in clinical practice, according to their own clinical experience. Results: Evidence regarding the long-term use (>15 months) of dienogest for the management of endometriosis is presented, with experts concluding that the efficacy of dienogest should be assessed primarily on its impact on pain and quality of life. Fertility preservation, the option to avoid or delay surgery, and managing bleeding irregularities that can occur with this treatment are also considered. Counseling women on potential bleeding risks before starting treatment may be helpful, and evidence suggests that few women discontinue treatment for this reason, with the benefits of treatment outweighing any impact of bleeding irregularities. Conclusions: Overall, the evidence demonstrates that dienogest offers an effective and tolerable alternative or adjunct to surgery and provides many advantages over combined hormonal contraceptives for the treatment of endometriosis. It is important that treatment guidelines are followed and care is tailored to the woman's individual needs and desires.

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Dienogest therapy during the early stages of recurrence of endometrioma might be an alternative therapeutic option to avoid repeat surgeries

Abstract: DNG therapy early after recurrence of postsurgical endometrioma appears to be viable for reducing the risk of repeated surgery.

Cited by 27 publications

References 26 publications

Gastrointestinal and Urinary Tract Endometriosis: A Review on the Commonest Locations of Extrapelvic Endometriosis

Gastrointestinal and Urinary Tract Endometriosis: A Review on the Commonest Locations of Extrapelvic Endometriosis

Postoperative hormonal treatment for prevention of endometrioma recurrence after ovarian cystectomy: a systematic review and network meta‐analysis

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

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