Short-term histopathological effects of dienogest therapy on ovarian endometriomas: in vivo, nonrandomized, controlled trial

Abstract

Ovarian endometriosis is a common gynecological disorder. To date, progestins are recommended as the first-line medical treatment for symptomatic ovarian endometriosis. The aim of this study was to evaluate the main histopathological effects of short-term dienogest therapy in patients with ovarian endometriomas scheduled for surgery. A prospective, nonrandomized controlled trial, including 70 symptomatic women with single ovarian endometriotic cyst (diameter between 30–50 mm) was conducted. Women scheduled for surgery were divided into two groups, depending on the treatment established at enrollment: 36 women received progestin therapy with dienogest (P group) and 34 women received no therapy (C group). At histopathological examination necrosis, inflammation, decidualization, glandular atrophy and angiogenesis were blindly evaluated. At tissue level, decidualization was significantly more frequent in P group compared to C group (p = .001). A nonsignificant tendency (p = .29) towards a slight decreased inflammation in P group was found. No significant differences were observed between the two groups in terms of necrosis, glandular atrophy and angiogenesis. The study suggests that high decidualization rate and the tendency to reduced inflammatory reaction in the short-term administration of dienogest might contribute to its therapeutic efficacy.

Chinese abstract

卵巢子宫内膜异位囊肿是一种常见的妇科疾病。目前, 孕激素被推荐为有症状的卵巢子宫内膜异位囊肿的一线治疗药物。本研究的目的是评估计划接受手术的卵巢子宫内膜异位囊肿患者短期地诺孕素治疗的主要组织病理学效果。一项前瞻性、非随机对照试验招募了70名有症状的单侧卵巢异位囊肿（直径在30-50mm）的女性。计划接受手术的女性根据招募时确定的治疗方法分为两组：36名女性接受地诺孕素治疗（P组）和34名女性未接受治疗（C组）。通过组织病理学检查盲法评估坏死、炎症、蜕膜化、腺体萎缩和血管生成。在组织学水平, P组发生蜕膜化较C组更频繁（p=.001）。P组炎症程度轻度下降但无显著趋势（p=.29）。两组间在坏死、腺体萎缩和血管形成方面未观察到显著差异。该研究显示, 短期地诺孕素治疗中高蜕膜化率和减少炎症反应的趋势可能有助于其疗效。

Keywords:

• Ovarian endometriosis
• dienogest
• progestins
• histopathological features

Disclosure statement

The authors declare that they have no conflict of interest. The authors received no financial support for the research, authorship, and/or publication of this article.