Medical treatment of ovarian endometriomas: a prospective evaluation of the effect of dienogest on ovarian reserve, cyst diameter, and associated pain

Abstract

The aim of the present study was to evaluate the effect of medical treatment of ovarian endometriomas on cyst diameter, associated pain, and ovarian reserve as measured with antral follicle count (AFC) and anti-Mullerian hormone (AMH). In this prospective study, 32 patients with unilateral endometrioma associated with pelvic pain, underwent 6-month medical treatment with dienogest. Before treatment, and at the end of 6 months of treatment, patients underwent evaluation of endometrioma diameter and AFC at transvaginal ultrasonography, measurement of AMH, and evaluation of associated pain. Mean cyst diameter was 4.0 ± 1.3 cm at baseline, and 2.4 ± 1.2 cm after 6 months of treatment (p < .0001), for a reduction in diameter of 40% and a reduction in volume of 79%. Mean visual analog scale score at enrollment was 6.3 ± 2.0, with a significant improvement at 6 months (0.9 ± 1.0, p < .0001). AFC for the affected ovary improved from 4.2 ± 2.8 at baseline, to 8.6 ± 4.2 cm after 6 months (+105%; p < .0001). AMH did not change significantly from baseline (3.40 ± 2.32 ng/mL) to end of treatment (2.80 ± 1.90 ng/mL, –18%, p = .27). Medical treatment with dienogest significantly reduces endometrioma diameter and associated pain, whereas the ovarian reserve appears to be preserved, with a significant improvement of AFC and no significant change in AMH.

摘要

本研究的目的是评估药物治疗卵巢子宫内膜异位症对囊肿直径、相关疼痛和卵巢储备功能窦卵泡数（AFC）和抗苗勒管激素（AMH）的影响。在此项前瞻性研究中, 32例伴有盆腔疼痛的单侧卵巢子宫内膜异位症患者接受了为期6个月的药物治疗。在治疗前和治疗6个月结束时, 患者接受了子宫内膜异位囊肿直径、经阴道超声测量AFC、AMH的检测和相关疼痛的评估。平均囊肿直径基线为4.0±1.3cm, 治疗6个月后为2.4±1.2cm (p<.0001), 囊肿直径缩小40%, 体积缩小79%。入组时疼痛平均视觉模拟评分为6.3±2.0, 治疗6个月后有显著的改善 (0.9±1.0, p<.0001)。受影响的卵巢的AFC从基线的4.2±2.8, 6个月后提高到的8.6±4.2cm (+105%; p<.0001)。AMH从基线的(3.40±2.32ng/mL)到治疗结束后的(2.80±1.90ng/mL, -18%, p=.27)无显著改变。地诺孕素药物治疗显著降低了子宫内膜异位症的囊肿直径及相关疼痛, 而卵巢储备功能似乎得到了保留, AFC明显改善, 而AMH无明显改善。

The Chinese abstracts are translated by Prof. Dr. Xiangyan Ruan and her team: Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.

Keywords:

• Anti-Mullerian hormone
• antral follicle count
• dienogest
• endometrioma
• ovarian reserve

Acknowledgments

The authors acknowledge Elisa Muzii, King’s College London, for assistance in the revision of the manuscript.

Disclosure statement

The authors report no conflicts of interest.