Comments on the "Impact of dienogest therapy on CA125 levels, hormonal profile, and systemic inflammatory indices in endometriosis"

Erkan Mavigök
Journal of Controversies in Obstetrics & Gynecology and Pediatrics · 2026 · vol. 4(3) , pp. 79–82 · doi:10.51271/jcogp-0078 · W7172303407
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This letter critiques a study on dienogest for endometriosis, arguing that methodological limitations and unchanged inflammatory indices limit claims of the drug's anti-inflammatory effects or clinical significance.

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This letter critiques a study by Bulut Arıkan and Sağsöz regarding the impact of dienogest therapy on CA125 levels, hormonal profiles, and systemic inflammatory indices in women with endometriosis. The authors highlight that while the original report noted reductions in specific markers like platelet-to-lymphocyte ratio, critical indices such as neutrophil-to-lymphocyte ratio remained unchanged, challenging claims of broad anti-inflammatory effects. Furthermore, the critique emphasizes that the retrospective, single-center, uncontrolled design and small effect sizes limit the ability to infer causality or clinical significance from the findings. This paper is centrally about endometriosis — specifically serving as a methodological commentary on the interpretation of dienogest’s anti-inflammatory and hematological effects in this condition.

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Abstract

Endometriosis is increasingly recognized as a systemic inflammatory condition, and dienogest is widely used as a medical treatment option. In their recent article, Bulut Arıkan and Sağsöz reported that dienogest therapy in women with endometriosis was associated with reductions in CA125, platelet-to-lymphocyte ratio (PLR), leukocyte count, and plateletcrit, alongside small increases in hemoglobin, hematocrit, and red blood cell indices. Based on these findings, the authors suggested that dienogest may exert anti-inflammatory effects and preserve endocrine homeostasis. In this letter, we highlight several methodological and interpretative issues that warrant caution. The retrospective, single-center, uncontrolled pre–post design and generally small effect sizes limit the extent to which causality and clinical significance can be inferred. Moreover, key systemic inflammatory indices such as neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, and systemic inflammation response index did not change significantly, which argues against a broad systemic anti-inflammatory effect. Finally, the proposed mechanisms for hematological improvement and endocrine safety remain speculative in the absence of detailed clinical outcomes.
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Abstract

1. Bulut Arıkan F, Sağsöz N. Impact of dienogest therapy on CA125 levels, hormonal profile, and systemic inflammatory indices in endometriosis. J Controv Obstetr Gynecol Ped. 2026;4(2):25-30. doi:10.51271/JCOGP-0069 2. Parasar P, Ozcan P, Terry KL. Endometriosis: epidemiology, diagnosis and clinical management. Curr Obstet Gynecol Rep. 2017;6(1):34-41. doi:10.1007/s13669-017-0187-1 3. Araştırma Türleri. Hacettepe Üniversitesi Biyoistatistik Anabilim Dalı. “Araştırma Türleri” eğitim notu (PDF). Erişim tarihi: 14 May 2026. 4. Kurt DS, Akay A, Ulusoy CO, Kurt A, Karabay G, Keskin HL. Evaluation of serum-based inflammatory and haematological markers in patients with endometriosis: a case-control study. Eur J Obstet Gynecol Reprod Biol. 2025;315:114751. doi:10.1016/j.ejogrb.2025.114751 5. Gete DG, Doust J, Mortlock S, Montgomery G, Mishra GD. Risk of iron deficiency in women with endometriosis: a population-based prospective cohort study. Womens Health Issues. 2024;34(3):317-324. doi:10.1016/j.whi.2024.03.004 Endometriosis is increasingly recognized as a systemic inflammatory condition, and dienogest is widely used as a medical treatment option. In their recent article, Bulut Arıkan and Sağsöz reported that dienogest therapy in women with endometriosis was associated with reductions in CA125, platelet-to-lymphocyte ratio (PLR), leukocyte count, and plateletcrit, alongside small increases in hemoglobin, hematocrit, and red blood cell indices. Based on these findings, the authors suggested that dienogest may exert anti-inflammatory effects and preserve endocrine homeostasis. In this letter, we highlight several methodological and interpretative issues that warrant caution. The retrospective, single-center, uncontrolled pre–post design and generally small effect sizes limit the extent to which causality and clinical significance can be inferred. Moreover, key systemic inflammatory indices such as neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, and systemic inflammation response index did not change significantly, which argues against a broad systemic anti-inflammatory effect. Finally, the proposed mechanisms for hematological improvement and endocrine safety remain speculative in the absence of detailed clinical outcomes.

Keywords

CA125, inflammation, endometriosis 1. Bulut Arıkan F, Sağsöz N. Impact of dienogest therapy on CA125 levels, hormonal profile, and systemic inflammatory indices in endometriosis. J Controv Obstetr Gynecol Ped. 2026;4(2):25-30. doi:10.51271/JCOGP-0069 2. Parasar P, Ozcan P, Terry KL. Endometriosis: epidemiology, diagnosis and clinical management. Curr Obstet Gynecol Rep. 2017;6(1):34-41. doi:10.1007/s13669-017-0187-1 3. Araştırma Türleri. Hacettepe Üniversitesi Biyoistatistik Anabilim Dalı. “Araştırma Türleri” eğitim notu (PDF). Erişim tarihi: 14 May 2026. 4. Kurt DS, Akay A, Ulusoy CO, Kurt A, Karabay G, Keskin HL. Evaluation of serum-based inflammatory and haematological markers in patients with endometriosis: a case-control study. Eur J Obstet Gynecol Reprod Biol. 2025;315:114751. doi:10.1016/j.ejogrb.2025.114751 5. Gete DG, Doust J, Mortlock S, Montgomery G, Mishra GD. Risk of iron deficiency in women with endometriosis: a population-based prospective cohort study. Womens Health Issues. 2024;34(3):317-324. doi:10.1016/j.whi.2024.03.004 Article Information Received : 18 May 2026 Accepted : 22 Haz 2026 Published : 30 Tem 2026 Accepted : 22 Haz 2026 Published : 30 Tem 2026 Corresponding Author : [email protected] Erkan Mavigök: Department of Obstetrics and Gynecology, Private Megapoint Hospital, Kahramanmaraş, Turkiye Citation : Mavigök E. Comments on the interpretation of the effects of dienogest therapy on CA125 and systemic inflammatory indices in endometriosis. J Controv Obstetr Gynecol Ped. 2026;4(3):79-82. doi:10.51271/JCOGP-0078

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