Is dienogest the best medical treatment for ovarian endometriomas? Results of a multicentric case control study

Abstract

Ovarian endometriomas are common manifestations of endometriosis. Surgical excision has been shown to potentially decrease ovarian reserves. In this prospective study, we included 81 patients with ovarian endometriosis. 40 were treated with 2 mg of dienogest daily (DNG) and 41 were treated with cyclic oral estro-progestins (ethinyl estradiol 30 mcg [EE] plus dienogest 2 mg) (DNG + EE). Aim of the study was the effect of the treatment on the size of the endometriotic cysts. Further, in the symptomatic patients, follow-up included an evaluation of chronic pain before and during treatment. Both treatments were able to significantly decrease the pain in symptomatic patients with no statistical differences. The mean visual analog scale score at enrollment was 65 ± 14 and 70 ± 18, and there was significant improvement (19 ± 15, p < .001, DNG; 18 ± 12, p < .001, DNG + EE). The size of the endometrioma cysts were significantly reduced in the DNG group. The mean cyst diameter was 52 ± 22 mm at baseline and 32 ± 12 mm after six months of treatment (p < .001), yielding a 75% volume reduction in DNG group. The decrease in the size of endometrioma cysts observed in the women treated with only progestin could be noteworthy, as it may reduce the negative impacts on the affected ovary and avoid surgery.

摘要

卵巢子宫内膜异位囊肿是子宫内膜异位症的常见表现。手术切除已被证明可能减少卵巢储备。在这项前瞻性研究中, 我们纳入了81名卵巢子宫内膜异位症患者。 40例接受每日2 mg的地诺孕素（DNG）治疗, 41例经周期口服雌激素-孕激素（乙炔雌二醇30 mcg [EE]加2mg地诺孕素）（DNG + EE）治疗。该研究的目的是探究不同治疗对卵巢子宫内膜异位囊肿大小的影响。此外, 在有症状患者中, 随访包括对治疗前和治疗中慢性疼痛的评估。两种治疗均能够显著减轻有症状患者的疼痛, 无统计学差异。入组时患者平均视觉模拟量表评分为65 ± 14和70 ± 18, 治疗后有显著改善（19 ± 15, p <.001, DNG； 18 ± 12, p <.001, DNG + EE）。 DNG组卵巢子宫内膜异位囊肿的大小明显缩小。平均囊肿直径在基线时为52 ± 22 mm, 在治疗六个月后为32 ± 12 mm（p <.001）, DNG组囊肿体积缩小了75％。在仅使用孕激素治疗的妇女中观察到的子宫内膜异位囊肿大小的缩小可能是值得注意的, 因为它可以减轻对患侧卵巢的不利影响并避免手术。

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:

• Endometriosis
• endometrioma
• dienogest
• ultrasound

Disclosure statement

The authors report no conflict of interests.