Metformin Efficiency in Genital Endometriosis Management

Maria I. Yarmolinskaya, Margarita S. Florova
In: Doctor.Ru · 2021 · vol. 20(6) , pp. 62–67 · doi:10.31550/1727-2378-2021-20-6-62-67 · W3202215282
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

Dienogest combined with 1,500mg Metformin daily improved endometriosis-associated pain syndrome more effectively than Dienogest alone.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This open-label prospective randomized block study assessed clinical effectiveness of metformin “off-label” for pain associated with externally genital endometriosis in 146 women, comparing metformin alone (1500 mg/day) to standard dienogest (2 mg/day) and two combined regimens (dienogest 2 mg/day with metformin 750 or 1500 mg/day) over 6 months. Pain outcomes (dysmenorrhea, dyspareunia, and chronic pelvic pain) were measured using a visual analogue scale at baseline and at 6 months, and treatment was recommended to start from day 5 of the menstrual cycle. The study found that pain frequency and severity decreased significantly in all groups, with the highest proportions reporting improvement observed for combined therapy with dienogest plus 1500 mg metformin (85.2%) and 750 mg metformin (75.9%), compared with dienogest alone (78.1%) and metformin alone (66.7%). A major limitation is the open-label, randomized but uncontrolled design with unclear allocation concealment/blinding and restriction of inclusion/exclusion criteria (e.g., exclusion of obesity, diabetes, and PCOS). This paper is centrally about endometriosis—evaluating metformin (alone and with dienogest) for pain management in externally genital endometriosis.

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Abstract

Study Objective: To assess clinical efficiency of combination therapy with Metformin and Metformin monotherapy in the management of endometriosis genitalis externa (EGE). Study Design: perspective randomised singe-arm study in parallel groups. Materials and Methods. 146 patients with pain syndrome associated with endometreosis were treated with one therapy option for 6 months: Dienogest 2mg/d (group 1, n = 32); Dienogest 2mg/d + Metformin 1,500mg/d (group 2, n = 61); Dienogest 2mg/d + Metformin 750mg/d (group 3, n = 29); Metformin 1,500 mg/d (group 4, n = 24). The intensity and prevalence of dysmenorrhea, dyspareunea, chronic pelvis pain (CPP) before and after treatment were evaluated. Study Results. In group 2, pain syndrome became less intensive in 85.2% of EGE patients. Dysmenorrhea reduction was statistically more frequent (p = 0.031), CPP was less intensive (p = 0.027), as compared to the standard Dienogest therapy. 75.9% of group 3 patients and 66.7% of group 4 patients had less intensive pain syndrome. There were no statistically significant differences in therapy results between group 3 and group 4 and Dienogest monotherapy. Conclusion. Combination of Dienogest (2mg/day) and Metformin (1,500mg/d) allows boosting the efficiency of therapy of endometreosis-associated pain syndrome. Personification of pathogen-specific EGE management with individualised selection of a drug combination and Metformin dose is a promising option. Keywords: endometreosis, pain syndrome, Dienogest, Metformin

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endometriosisdysmenorrhea

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