Dienogest versus continuous oral levonorgestrel/EE in patients with endometriosis: what’s the best choice?

Abstract

Objective

Combined oral contraceptives (COC) and progestogens are widely used for the treatment of endometriosis. The objective of the study is to compare the efficacy of dienogest 2 mg vs continuous oral levonorgestrel/EE (levonorgestrel 0.1 mg/ethinyl estradiol 0.02 mg) on ovarian endometriomas, deep infiltrating endometriosis (DIE), chronic pelvic pain (CPP), dyspareunia, analgesic use, quality of life (QoL), compliance and side effects.

Methods

Prospective cohort study. Two cohorts of patients with endometriosis, 50 taking dienogest (group A) and 50 taking continuous levonorgestrel/EE (group B), were evaluated at the beginning of therapy (t0), after 3 (t3) and 6 months (t6). Size of endometriomas, DIE, QoL, pain symptoms, and side effects were assessed.

Results

Dienogest was significantly effective on CPP (p = .002), dyspareunia (p = .021) ovarian endometriomas (p = .015) and DIE lesions reduction (p = .014). Levonorgestrel/EE was significantly effective on dyspareunia (p = .023). Analgesics consumption significantly decreased in both groups (p < .001). Both treatments significantly improved the QoL. Over 6 months a significant improvement was found, more frequently in patients taking dienogest. The only side effect that both groups complained about was vaginal bleeding, present in the first 3 months of treatment (p < .001).

Conclusions

Both treatments are effective and safe for patients with endometriosis. Patients compliance and side effects are similar in both groups, however, there was a significantly higher reduction in endometriotic lesions, pain symptoms, and improvement of the QoL in women taking dienogest than in women taking continuous COC.

摘要

目的:复方口服避孕药(COC)和孕激素广泛用于治疗子宫内膜异位症。本研究的目的是比较服用地诺孕素2mg与连续服用左炔诺孕酮/炔雌醇(左炔诺孕酮0.1mg/炔雌醇0.02 mg)对卵巢子宫内膜异位囊肿、深部浸润型子宫内膜异位症(DIE)、慢性盆腔疼痛(CPP)、性交困难、镇痛药使用、生活质量(QoL)、依从性和副作用的疗效。

方法:前瞻性队列研究。两组子宫内膜异位症患者, 50例服用地诺孕素(A组)和50例连续服用左炔诺孕酮/炔雌醇(B组), 在治疗开始(t0)、3个月(t3)和6个月后(t6)进行评估。评估子宫内膜异位囊肿的大小、深部浸润型子宫内膜异位症、生活质量、疼痛症状和副作用。

结果:地诺孕素对慢性盆腔疼痛(p= .002)、性交困难(p= .021)、卵巢子宫内膜异位囊肿(p= .015)和深部浸润型子宫内膜异位病变减少(p= .014)有显著疗效。左炔诺孕酮/炔雌醇对性交困难有显著疗效(p= .023)。两组镇痛药的使用量均显著下降(p < .001)。两种治疗都显著改善了生活质量。治疗6个月后发现有显著改善, 其中在服用地诺孕素的患者中更为常见。两组患者主诉唯一副作用是阴道流血, 症状出现在治疗的前3个月(p < .001)。

结论:两种治疗方法对子宫内膜异位症患者均有效且安全。两组患者的依从性和副作用相似, 然而, 服用地诺孕素的女性子宫内膜异位病变、疼痛症状的减少和生活质量的改善明显高于连续服用COC的女性。

Keywords:

• Pain
• quality of life
• endometriosis
• levonorgestrel
• dienogest

Disclosure statement

The authors report no conflict of interests.