Dienogest and the Risk of Endometriosis Recurrence Following Surgery
Journal of Minimally Invasive Gynecology: Published on December 2020
Endometriosis is a common condition affecting women of reproductive age, often presenting with pelvic pain and infertility. In addition to significantly impacting a woman’s quality of life, the treatment of endometriosis carries a considerable economic burden.
TAKE HOME MESSAGE:
Surgery can help relieve symptoms, restore anatomy and improve fertility outcomes.
However, endometriosis recurrence rates following surgery are high and patients remain at risk of requiring re-intervention. Re-operation rates following endometriosis surgery in which the ovaries are preserved have been reported as between 27% and 58%.
Post-operative hormonal suppression has been proposed as a means of reducing the need for re-intervention following conservative (ovarian sparing) surgery for endometriosis.
Study objective was to determine whether dienogest therapy after endometriosis surgery reduces the risk of endometriosis recurrence compared with expectant management.
The incidence rate of endometriosis recurrence in patients treated with dienogest was 2 per 100 women over a mean follow-up of 29 months versus 29 per 100 women managed expectantly over a mean follow-up of 36 months.
The likelihood of recurrence was significantly reduced with postoperative Dienogest.
Conclusion
Patients receiving dienogest after conservative surgery for endometriosis had significantly lower risk of postoperative disease recurrence than those who were expectantly managed.
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Study Objective
To determine whether dienogest therapy after endometriosis surgery reduces the risk of endometriosis recurrence compared with expectant management.
Data Sources
Ovid MEDLINE, Ovid EMBASE, PubMed, Cochrane Central Register of Controlled Trials, Web of Science, LILACS, clinicaltrials.gov, and International Standard Randomized Controlled Trial Number Registry were searched from inception to March 2019 for observational and randomized controlled trials.
Methods of Study Selection
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Medical Subject Heading terms and keywords such as “dienogest,” “endometriosis,” and “recurrence” were used to identify relevant studies.
Tabulation, Integration, and Results
The search yielded 328 studies, 10 of which were eligible for inclusion, representing 1184 patients treated with dienogest and 846 expectantly managed controls. Among these studies, 9 looked exclusively at endometrioma recurrence, whereas 1 used reappearance of symptoms as evidence of disease recurrence. Data on both incidence of and time to recurrence of endometriosis were extracted.
The incidence rate of endometriosis recurrence in patients treated with dienogest was 2 per 100 women over a mean follow-up of 29 months versus 29 per 100 women managed expectantly over a mean follow-up of 36 months. The likelihood of recurrence was significantly reduced with postoperative dienogest.
Conclusion
Patients receiving dienogest after conservative surgery for endometriosis had significantly lower risk of postoperative disease recurrence than those who were expectantly managed.
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