From size to shape: morphological ultrasound remodelling of large ovarian endometriomas under dienogest therapy

Veronica Yacoub, Consuelo Russo, Aikaterini Selntigia, Giulia Monaco, Elvira Nocita, Sara Valeriani, S. Valeriani, Giorgia Soreca, Alfredo Ercoli, Caterina Exacoustos, C. Exacoustós
Reproductive BioMedicine Online · 2026 · vol. 53(5) , pp. 105917 · doi:10.1016/j.rbmo.2026.105917 · PMID:42704949 · W7202378131
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Dienogest significantly reduces volume and alters morphological ultrasound features of large ovarian endometriomas over 24 months, while improving symptoms and downstaging Enzian scores.

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Abstract

RESEARCH QUESTION: What is the long-term efficacy of dienogest in treating large ovarian endometriomas (≥5 cm), assessed by transvaginal sonography (TVS) changes in size, greyscale, colour Doppler features, #Enzian score and symptoms over time? DESIGN: This retrospective observational study included 51 participants with a TVS-diagnosed ovarian endometrioma of ≥5 cm, treated with dienogest 2 mg daily. TVS was performed at 6, 12 and 24 months (24-month data being available for 35 patients), using International Ovarian Tumor Analysis terminology and #Enzian score. Pain was assessed by a visual analogue scale, and menstrual blood loss by self-perception. RESULTS: In total 54 endometriomas were analysed. The mean maximum diameter decreased from 60.0 mm (95% CI 55.9-64.1 mm) at baseline to 38.9 mm (95% CI, 34.8-43.0 mm) at 6 months (P < 0.001), and the reduction was sustained at 24 months (P < 0.001). The mean volume decreased from 70.8 ml (95% CI 61.1-80.6 ml) at baseline to 27.7 ml (95% CI 17.9-37.4 ml) at 6 months (P < 0.001), with the reduction persisting at 24 months (P < 0.001). The frequency of ground-glass content decreased from 90.7% (49/54) to 66.7% (36/54) at 6 months (P < 0.001). Wall collapse was observed in 2/54 (3.7%) cases at baseline and 8/54 (14.8%) at 12 months (6 versus 12 months, P = 0.028). The frequency of a colour Doppler score of 1 increased from 48.1% (26/54) at baseline to 66.7% (36/54) at 6 months, (P < 0.001). The proportion of patients with #Enzian #O1 endometriomas was 40.7% (22/54) at 12 months, compared with no cases at baseline (P < 0.001). Severe dysmenorrhoea and heavy menstrual bleeding frequency improved by 6 months. CONCLUSIONS: Dienogest is effective in reducing the volume of large ovarian endometriomas and downstaging the #Enzian score. Recognizing therapy-related TVS changes may avoid misinterpretation as atypical lesions and guide follow-up.

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chemicals 3
dienogest dienogest dienogest

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