Comparative Efficacy of Dienogest and Cabergoline in Pain Relief and Size Reduction of Ovarian Endometriomas: A Prospective Study

Comparative Efficacy of Dienogest and Cabergoline in Pain Relief and Size Reduction of Ovarian Endometriomas: A Prospective Study Downloads Endometriosis is a condition in which the growth of endometrial tissue occurs outside its typical location (most frequently the ovaries, where endometriomas form). This disease is the main reason for chronic pelvic pain and infertility in women of reproductive age. In this prospective comparative study, 50 women with ultrasound-detected ovarian endometriomas and pelvic pain were enrolled. They were randomly assigned to receive cabergoline 0.5 mg twice a week or dienogest 2 mg once a day for three months. The primary outcomes were changes in endometrioma size and pain scores. After the treatment, dienogest reduced the mean cyst diameter to a greater extent (around 19.7% compared to 8.77% with cabergoline), while cabergoline resulted in a slightly higher average reduction in visual analog scale pain scores (73% compared to 65% with dienogest), but this difference was not statistically significant. Both treatment regimens were generally well tolerated, with only mild and transient adverse effects reported. The results indicate that dienogest could be the drug of choice if the main therapeutic goal is to shrink the endometrioma, whereas cabergoline might be the drug of choice if pain relief and fertility preservation are prioritized. Therefore, larger and longer-term studies are needed to verify these observations. Burney RO, Giudice LC. Pathogenesis and pathophysiology of endometriosis. Fertil Steril. 2012;98(3):511–519. doi:10.1016/j.fertnstert.2012.06.029. Dunselman GA, Vermeulen N, Becker C, et al. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014;29(3):400–412. doi:10.1093/humrep/det457. Raffaelli R, Garzon S, Baggio S, et al. Mesenteric vascular and nerve sparing surgery in laparoscopic segmental intestinal resection for deep infiltrating endometriosis. Eur J Obstet Gynecol Reprod Biol. 2018;231:214–219. doi:10.1016/j.ejogrb.2018.10.057. Nezhat F, Nezhat C, Allan CJ, et al. Clinical and histologic classification of endometriomas. Implications for a mechanism of pathogenesis. J Reprod Med 1992;37(9):771–776. PMID: 1453396. Donnez J, Nisolle M, Gillet N, et al. Large ovarian endometriomas. Hum Reprod 1996;11(3):641–646. DOI: 10.1093/humrep/11.3.641. Marquardt RM, Kim TH, Shin JH, et al. Progesterone and estrogen signaling in the endometrium: What goes wrong in endometriosis. Int J Mol Sci 2019;20(15):3822. DOI: 10.3390/ijms20153822. Laganà AS, Garzon S, Götte M, et al. The pathogenesis of endometriosis: molecular and cell biology insights. Int J Mol Sci. 2019;20(22):5615. doi:10.3390/ijms20225615 Terzic M, Aimagambetova G, Garzon S, et al. Ovulation induction in infertile women with endometriotic ovarian cysts: current evidence and potential pitfalls. Minerva Med. 2019. doi:10.23736/S0026-4806.19.06346-8. Busacca M, Riparini J, Somigliana E, et al. Postsurgical ovarian failure after laparoscopic excision of bilateral endometriomas. Am J Obstet Gynecol 2006;195(2):421–425. DOI:10.1016/j.ajog.2006.03.064. Rolla E. Endometriosis: advances and controversies in classification, pathogenesis, diagnosis, and treatment [version 1; peer review: 4 approved] F1000Research 2019, 8(F1000 Faculty Rev):529 https://doi.org/10.12688/f1000research.14817. Llarena N, Flyckt R. Strategies to preserve and optimize fertility for patients with endometriosis. J Endometr Pelvic Pain Disord 2017;9:98–104. DOI: 10.5301/jeppd.5000278. Ruan X, Seeger H, Mueck AO (April 2012). "The pharmacology of dienogest". Maturitas. 71 (4): 337–344. doi:10.1016/j.maturitas.2012.01.018. PMID 22364708. Micks EA, Jensen JT (January 2013). "Treatment of heavy menstrual bleeding with the estradiol valerate and dienogest oral contraceptive pill". Advances in Therapy. 30 (1): 1–13. doi:10.1007/s12325-012-0071-3. PMID 23239397. S2CID 31125733 Bizzarri N, Remorgida V, Leone Roberti Maggiore U, Scala C, Tafi E, Ghirardi V, et al. (September 2014). "Dienogest in the treatment of endometriosis". Expert Opinion on Pharmacotherapy. 15 (13): 1889–1902. doi:10.1517/14656566.2014.943734. PMID 25069386. S2CID 37627607. Angioni S, Pontis A, Malune ME, Cela V, Luisi S, Litta P. Is dienogest the best medical treatment for ovarian endometriomas? Results of a multicentric case control study. Gynecol Endocrinol. 2020 Jan;36(1):84-86. Techatraisak K, Hestiantoro A, Soon R, Banal-Silao MJ, Kim MR, Seong SJ, et al. Impact of Long-Term Dienogest Therapy on Quality of Life in Asian Women with Endometriosis: the Prospective Non-Interventional Study ENVISIOeN. Reprod Sci. 2022 Apr;29(4):1157-1169. Ruan X, Seeger H, Mueck AO (April 2012). "The pharmacology of dienogest". Maturitas. 71 (4): 337–344.doi:10.1016/j.maturitas.2012.01.018. PMID 22364708. "Cabergoline: MedlinePlus Drug Information". medlineplus.gov. Retrieved 2023-10-22 Kvernmo T, Houben J, Sylte I: Receptor-binding and pharmacokinetic properties of dopaminergic agonists. Curr Top Med Chem. 2008;8(12):1049-67. Asante A., Taylor R.N. Endometriosis: the role of neuroangiogenesis. Annu Rev Physiol. 2011;73:163–182. doi: 10.1146/annurev-physiol-012110-142158. [DOI] [PubMed] [Google Scholar] Nap A.W., Griffioen A.W., Dunselman G.A., Bouma-Ter Steege J.C., Thijssen V.L., Evers J.L., et al. Antiangiogenesis therapy for endometriosis. J Clin Endocrinol Metab. 2004;89:1089–1095. doi: 10.1210/jc.2003-031406 Elice F., Rodeghiero F. Side effects of anti-angiogenic drugs. Thromb Res. 2012;129:S50–S53. doi: 10.1016/S0049-3848(12)70016-6. Vincent K, Kennedy S, Stratton P. Pain scoring in endometriosis: entry criteria and outcome measures for clinical trials. Report from the Art and Science of Endometriosis meeting. Fertil Steril 2010; 93:62-7. Maddern J, Grundy L, Castro J, Brierley SM. Pain in Endometriosis. Front Cell Neurosci. 2020 Oct 6;14:590823 Biberoglu Ko, Behrman SJ. dosage aspects of danazol therapy in endometriosis: short-term and long-term effectiveness. Am J obstet Gynecol 1981 15; 139: 645-54. Zondervan K.T., Becker C.M., Missmer S.A. Endometriosis. N Engl J Med. 2020;382:1244–1256. doi: 10.1056/NEJMra1810764. [DOI] [PubMed] [Google Scholar] Barbara G, Buggio L, Facchin F, Vercellini P. Medical Treatment for Endometriosis:Tolerability, Quality of Life and Adherence. Front Glob Womens Health. 2021 Sep 27;2:729601 Muzii L, Galati G, Mattei G, Chinè A, Perniola G, Di Donato V, et al. Expectant, Medical, and Surgical Management of Ovarian Endometriomas. J Clin Med. 2023 Feb 26;12(5):1858. Laganà AS, Salmeri FM, Ban Frangež H, et al. Evaluation of M1 and M2 macrophages in ovarian endometriomas from women affected by endometriosis at different stages of the disease. Gynecol Endocrinol. 2019. doi:10.1080/09513590.2019.1683821 Novella-Maestre E, Carda C, Ruiz-Sauri A, et al. Identification and quantification of dopamine receptor 2 in human eutopic and ectopic endometrium: a novel molecular target for endometriosis therapy. Biol Reprod. 2010;83(5):866–873. doi:10.1095/biolreprod.110.084392. Hamid, A.M.S.A., Madkour, W.A.I., Moawad, A. et al. Does Cabergoline help in decreasing endometrioma size compared to LHRH agonist? A prospective randomized study. Arch Gynecol Obstet 290, 677–682 (2014). https://doi.org/10.1007/s00404-014-3242-4 Kyal A, Pal A, Mukhopadhyay A, Mukhopadhyay P. Does Cabergoline Help in Decreasing Chronic Pelvic Pain Due to Endometriosis Compared to Medroxyprogesterone Acetate? A Prospective Randomized Study. J South Asian Feder Obs Gynae 2018; 10 (3):167-169. Park SY, Kim SH, Chae HD, Kim CH, Kang BM. Efficacy and safety of dienogest in patients with endometriosis: A single-center observational study over 12 months. Clin Exp Reprod Med. 2016 Dec;43(4):215-220. doi: 10.5653/cerm.2016.43.4.215. Epub 2016 Dec 26. PMID: 28090460; PMCID: PMC5234284. Uludag, S. Z., Demirtas, E., Sahin, Y., & Aygen, E. M. (2021). Dienogest reduces endometrioma volume and endometriosis-related pain symptoms. Journal of Obstetrics and Gynaecology, 41(8), 1246-1251. Lang, J., Yu, Q., Zhang, S., Li, H., Gude, K., von Ludwig, C., ... & Dong, L. (2018). Dienogest for treatment of endometriosis in Chinese women: a placebo-controlled, randomized, double-blind phase 3 study. Journal of Women's Health, 27(2), 148-155. Karslıoglu T, Karasu AF, Yildiz P. The effects of micronized progesterone and cabergoline on a rat autotransplantation endometriosis model: a placebo controlled randomized trial. J Invest Surg. 2021;34(8):897–901. doi:10.1080/08941939.2019.1705442. Chandra, A., Rho, A. M., Jeong, K., Yu, T., Jeon, J. H., Park, S. Y., ... & Chung, H. W. (2018). Clinical experience of long-term use of dienogest after surgery for ovarian endometrioma. Obstet Gynecol Sci, 61(1), 111-117. Mehnaz Mustary Shume, Jesmine Banu et al, The Effects of Cabergoline Compared to Dienogest in Women with Symptomatic Endometrioma, Fertility & Reproduction 2021 03:02, 49-54 Copyright (c) 2025 Dr. Raj Sekhar Sarkar, Santu Guin, Prof. (Dr.) Madhurima Chattopadhyay This work is licensed under a Creative Commons Attribution 4.0 International License. All Content should be original and unpublished.