Global Journal of Reproductive Medicine:

Endometriosis is a common disease in up to 10% of women of reproductive age. It often causes symptoms such as dysmenorrhea, chronic pelvic pain, dyspareunia and dyschezia. It is also associated with ovarian endometrioma which requires surgery for both diagnosis and treatment. However, recurrence rates are approximately 30-50% within 5 years after surgery.

TAKE HOME MESSAGE:

Dienogest is a new synthetic oral progestin that was approved for the treatment of endometriosis.

It works by preventing the growth of the endometrium and suppressing estrogen production.

Long-term dienogest showed a favorable safety and tolerability profile, including a low incidence of hypoestrogenic effects and minimal change in bone mineral density.

The aim of this study is to review literature and assess the efficacy of dienogest in the treatment of endometriosis.

Dienogest 2mg/day was superior to placebo in relieving pain symptoms in patients with endometriosis, equivalently effective to gonadotropin releasing hormone agonist (GnRHa). The size of endometriomas was reduced by use of dienogest.

Postoperative administration of dienogest showed the efficacy in relieving pain and suppressing recurrence of endometrioma in patients with endometriosis. Dienogest was also effective in relieving symptoms in women with deep infiltrating endometriosis (DIE) or extragenital endometriosis.

Dienogest is an alternative for the treatment of endometriosis because of its efficacy, safety and tolerability. Dienogest is a highly effective drug for postoperative treatment of patients with endometriosis. Dienogest significantly decreases the severity of pelvic pain and metrorrhagia after surgery.

Pain Relief

In a 12-week randomized placebo-controlled study involving 198 women, dienogest 2 mg/day was more effective than placebo for reducing endometriosis-associated pelvic pain. A study of one year-treatment demonstrated that dienogest showed pelvic pain reduction through the treatment period and the decrease of pelvic pain persisted for at least 24 weeks after treatment cessation.

Postoperative administration of dienogest showed a significant higher pelvic pain reduction than the expectant management group until 24 months of follow-up in a multi-center study. Dienogest prevented pelvic pain recurrence as effectively as GnRHa after laparoscopic surgery for endometriosis.

Ovarian Endometrioma

Treatment of dienogest over 12 months decreased the size of endometrioma to approximately 30% of the initial sizes and the similar effect was also observed in the patients of recurrent
endometrioma.

Deep Infiltrating Endometriosis (DIE)

DIE can affect the bowel and the urinary tract and causes severe pain. Dienogest is as effective as surgical treatment in relieving pain in more than 90% of women with DIE at one year follow-up [18]. Postoperative administration of dienogest significantly reduced the endometriosis-related pain in the DIE patients.

Extragenital Endometriosis

There are a few pilot studies describing the efficacy of dienogest on extragenital endometriosis.