{"paper_id":"ce58b881-7854-4826-a0bb-758afc8cc90b","body_text":"~ 240 ~ \nInternational Journal of Clinical Obstetrics and Gynaecology 2021; 5(4): 240-242 \n \nISSN (P): 2522-6614 \nISSN (E): 2522-6622 \n© Gynaecology Journal \nwww.gynaecologyjournal.com \n2021; 5(4): 240-242 \nReceived: 25-05-2021 \nAccepted: 29-06-2021 \n \nDr. Suchita Bajaj \nSenior Resident, Dept. of \nObstetrics and Gynaecology, \nKasturba Gandhi Hospital, \nDaryaganj, New Delhi, India \n \nDr. Nitin Madnani \nConsultant Radiologist, Dept. of \nRadio-Diagnosis, Rani Basant \nDiagnostic Centre, Allahabad, \nUttar Pradesh, India \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nCorresponding Author: \nDr. Nitin Madnani \nConsultant Radiologist, Dept. of \nRadio-Diagnosis, Rani Basant \nDiagnostic Centre, Allahabad, \nUttar Pradesh, India \n \nTo evaluate the effectiveness of dienogest in controlling \nbleeding abnormalities in endometriosis \n \nDr. Suchita Bajaj and Dr. Nitin Madnani \n \nDOI: https://doi.org/10.33545/gynae.2021.v5.i4d.994 \n \nAbstract \nBackground & Method: The present study was carried out in outdoor and indoor patients with an aim to \n“To e valuate the effectiveness of dienogest in controlling bleeding abnormalities in endometriosis” was \nconducted in the Department of Obstetrics and Gynaecology, Sri Aurobindo Medical College & P.G. \nInstitute, Indore M.P. Women with endometriosis and presence of at least one of the symptoms were \nincluded in the study. Study was done according to the regulations of the Institutional Ethics Committee. \nDetailed history was taken, general and gynaeco logical examinations were done.  According to patient’s \nsymptoms VAS and PLAB Scoring was done Either USG, MRI or if needed Laparoscopy was done. \nResult: The distribution of patients based on Symptoms of Endometriosis. An equal percentage of patients \ni.e. 40% had CPP (Chronic Pelvic Pain)+ Dysmenorrhea and CPP + Dysmenorr hea+ Heavy Menses \nfollowed by 10% who were having CPP + Dyspareunia + Dysmenorrhea, 8% had CPP+ infertility while, \nthe lowest percentage 2% had CPP+ infertility+ Heavy Bleeding. The distribution of patients based on their \nPT Satisfaction Score. The highest  percentage of patients i.e. 50% were Very Satisfied followed by 30% \nwho were Satisfied while, the lowest percentage 14% were Not Satisfied. \nConclusion: Endometriosis is a disease that requires a drawn out administration. Dienogest is by all \naccounts compe lling for the treatment of agony and draining irregularities, related with endometriosis. \nTaking everything into account our information shows that dienogest could further develop wellbeing \nrelated personal satisfaction of lady and diminishes in the view o f endometriosis related torment and \nsubstantial dying. In our examination 30% ladies have Adenomyosis as an accompanying disease and 24 % \nladies were has previous history of Adenomyosis. \n \nKeywords: Dienogest, bleeding abnormalities & endometriosis \n \nIntroduction  \nThe presence of endometrial glands and tissue outside the uterus is called Endometrium. \nEndometrioma is known as an endometrioid cyst [1]. Endometrioid cysts, often filled with dark, \nreddish-brown blood, may range in size from 0.75-8 inches. \nEndometriomas arise when an ovarian surface deposit of endometriosis adheres to another \nstructure, usua lly the broad ligament. The cyst then grows from trapped menstruation by \nprogressively invaginating the whole ovarian cort ex (cortical invagination cyst) [2]. From the \nsurgeon’s point of view, this process is most likely, because the majority of Endometriomas \nadhere to the peritoneum where rupture of the cysts almost always occurs during adhesiolysis.  \nMetaplasia of mesothelium lining the surface inclusion cyst  [3] and colonization of preexisting \nhemorrhagic corpus luteal cysts is caused by endometritis tissue  [4]. Additional theories for the \nformation of Endometrioma,  the possibility of intra -parenchymal endometritis deposits \ngenerating an ovarian endometritis cyst [5]. \n \nMaterial & method \nThe present study was carried out in outdoor and indoor patients with an aim to “To evaluate the \neffectiveness of dienogest in controlling bleeding abnormalities in endometriosis”  was \nconducted in the Department of Obstetrics and  Gynaecology, Sri Aurobindo Medical College & \nP.G. Institute, Indore M.P. from Sept 2016 to Sep 2018, total 100 patients. Women with \nendometriosis and presence of at least one of the symptoms were included in the study. Study \nwas done according to the regulations of the Institutional Ethics Committee. \n• Detailed history was taken, general and gynaecological examinations were done. \n• According to patient’s symptoms VAS and PLAB Scoring was done \n\n\nInternational Journal of Clinical Obstetrics and Gynaecology http://www.gynaecologyjournal.com \n~ 241 ~ \n• Either USG, MRI or if needed Laparoscopy was done \n \nInclusion criteria  \n• Women in the reproductive age group18-45 years \n• Women with endometriosis and presence of at least one of \nthe symptoms dysmenorrhea, infertility, chronic pelvic pain, \ndyspareunia \n• Woman who give consent. \n \nExclusion criteria  \n• Women with congenital or acquired uterine anomaly.  \n• Women with genital bleeding of unknown etiology.  \n• Women with other medical disorder like thyroid and \nbleeding disorder \n• Women with liver and heart disease.  \n• Women who had undergone a therapeutic surgical \nprocedure in past 6 months.  \n• Women with pregnancy as well as those with a desire \nimmediate pregnancy. \n \nResults \n \nTable 1: Distribution of cases based on history (h/o) of endometriosis \n \nH/O of Endometriosis No. of Cases % \nNo 76 76 \nYes 24 24 \nTotal 100 100 \n \nThe distribution of patients  based on History of Endometriosis. \nThe higher percentage of patients i.e. 76% were not having \nHistory of Endometriosis while, 24% were having it. \n \nTable 2: Distribution of case based on symptoms of endometriosis \n \nSymptoms No. of Cases % \nCPP + Dysmenorrhea 40 40 \nCPP + Dysmenorrhea + Heavy Menses 40 40 \nCPP + Dyspareunia + Dysmenorrhea 10 10 \nCPP+ Infertility 8 8 \nCPP+ Infertility + Heavy Bleeding 2 2 \nTotal 100 100 \n \nThe distribution of patients based on Symptoms of \nEndometriosis. An equal percentage of patients i.e. 40% had \nCPP (Chronic Pelvic pain)  + Dysmenorrhea and CPP + \nDysmenorrhea + Heavy Menses followed by 10% who were \nhaving CPP + Dyspareunia + Dysmenorrhea, 8% had CPP  + \ninfertility while, the lowest percentage 2% had CPP+ infertility  \n+ Heavy Bleeding. \n \nTable 3: Distribution based on the base of diagnosis laparoscopic \nfindings \n \nLaparoscopic Findings No. of Cases % \nSuperficial Deposit 14 14 \nAdhesion+ Hydrosalpinx 2 2 \nAdhesion 12 12 \nDeep Endometriosis 2 2 \nNot Done 70 70 \nTotal 100 100 \n \nThe di stribution of patients based on their Laparoscopic \nFindings. The highest percentage of patients i.e. 14% had \nSuperficial Deposit followed by 12% who were having \nAdhesion while, an equal percentage 2% had Adhesion+ \nHydrosalpinx and deep Endometriosis. \nTable 4: Distribution of case Based on PT Satisfaction Score \n \nPT Satisfaction Score No. of Cases % \nNot satisfied (0-3) 14 14 \nSatisfied (4 to7 ) 30 30 \nVery satisfied (8 -10) 50 50 \nTotal 100 100 \n \nThe distribution of patients based on their PT Satisfaction Sc ore. \nThe highest percentage of patients i.e. 50% were Very Satisfied \nfollowed by  30% who were Satisfied while, the lowest \npercentage 14% were Not Satisfied. \n \nDiscussion \nIn our examination 24% were having endometriosis. Then again \nTechatraisak K et al . [7] (2019) all patients 864/864 100% \npatients had history of endometriosis. In the examination Caruso \nS. et al. [8] (2018) most normal manifestation was constant pelvic \ntorment in 100% (n=51) ladies, dysmenorrhea n=50 (78.4%) and \nDyspareunia n=38 (74.5%). \nIn our examination practically same outcomes were found. Most \nnormal manifestation of endometriosis was constant pelvic \ntorment (100%), dysmenorrheal (half) and 42% ladies who gave \nsubstantial bleeding  [6]. Just 10% ladies had fruitlessness. In \nequivalent per cent of patients(40%) had Chronic pelvic \npain(CPP)+dysmenorrhea and CPP  + Dysmenorrhea + heavy \nmenses followed by 10% who were having CPP  + Dyspareunia + \ndysmenorrhea. 8% had CPP +  infertility while the lower percent \n2% had CPP + infertility + heavy menses.  \nIn the investigation Techatraisak K et al. [7] (2019) most normal \nside effect of endometrio sis was dysmenorrhea (n=684/865 ; \n79.1%) and constant pelvic agony (n=279/865;  32.3%), \nDyspareunia (5.9%). In the examination Techatraisak K et al . [7] \n(2019) N=616(71.2%) ladies were analyzed precisely or \nlaparoscopically and n=247  (28.6%) were analyzed clinically.  \n0.2% were missing  [9]. The determination of endometriosis \ndepends on clinical history, assessment and imaging. In our \nexamination n=15 (30%) of ladies  were analyzed \nlaparoscopically and by USG (TAS/TVS) n=35  (70%) were \nanalyzed. \n \nConclusion  \nEndometriosis is a disease that requires a drawn out \nadministration. Dienogest is by all accounts compelling for the \ntreatment of agony and draining irregularities,  related with \nendometriosis. Taking everything into account our information \nshows that dienogest could further develop wellbeing related \npersonal satisfaction of lady and diminishes in the view of \nendometriosis related torment and substantial dying. In our  \nexamination 30% ladies have Adenomyosis as an accompanying \ndisease and 24 % ladies were has previous history of \nAdenomyosis. \n \nReferences \n1. Schindler AE. Dienogest in long -term treatment of \nendometriosis, Int J Womens Health. 2011;3:175–184. \n2. Scurry J, Whiteh ead J, Healey  M. Classification of ovarian \nEndometriotic Cysts, Int J Gynecol Pathol. 2001;20:147 –\n154. \n3. Donnez J, Nisolle M, Gillet N, et al.  Large ovarian \nEndometriomas Hum Reprod. 1996;11:641–646. \n4. Nezhat F, Nezhat C, Allan CJ, et al. Clinical and histolog ic \nclassification of Endometriomas implications for a \nmechanism of pathogenesis , J Reprod Med. 1992;37:771 –\n776. \n\nInternational Journal of Clinical Obstetrics and Gynaecology http://www.gynaecologyjournal.com \n~ 242 ~ \n5. Michele Vignali, Gaia Maria Belloni, Giuliana Pietropaolo, \nAllegra Barbasetti Di Prun, Valeria Barbera, Stefano \nAngioni & Ida Pino, 2020. \n6. Effect of Dienogest therapy on the size of the \nEndometrioma, Gynecological Endocrinology. \nDOI: 10.1080/09513590.2020.1725965 \n7. Barra F, Scala C. Maggiore LR and Ferrero S. Long ‐Term \nAdministration of Dienogest for the Treatment of Pain and \nIntestinal Symptoms in P atients with Recto sigmoid  \nEndometriosis J. Clin Med. 2020;9:154. \nDOI: 10.3390/jcm9010154. \n8. Techatraisak K, Hestiantoro A, Ruey S, Banal -Silao MJ, \nKim MR, Seong SJ , et al.  Effectiveness of dienogest in \nimproving quality of life in Asian women with \nendometriosis ( ENVISIOEN): Interim results from a \nprospective cohort study under real life clinical practice  \nBMC Women's Health. 2019;19:68. \nhttps://doi.org/10.1186/s12905-019-0758-6. \n9. Caruso S, Iraci M, Cianci S, Fava V, Casella E, Cianci A.  \nEffects of long-term treatment with Dienogest on the quality \nof life and sexual function of women affected by \nendometriosis-associated pelvic pain, Journal of Pain \nResearch. 2019; 12:2371-2378. \nDOI: 10.2147/JPR.S207599. \n10. Shabina Khan, Sweety Raj, Shreshu Yadav. Safety and \nefficacy of dienogest in long t erm treatment of \nendometriosis, International Journal of contemporary \nmedical research. 2019;6(9):I1-I4. \nDOI: http://dx.doi.org/10.21276/ijcmr.2019.6.9.35","source_license":"CC0","license_restricted":false}