Endometrial preparation with Dienogest before hysteroscopic surgery: a systematic review

Purpose Hysteroscopic surgery is considered the gold standard for the minimal invasive treatment of many endouterine diseases such as endometrial polyps or submucous myomas. Recently, many studies have evaluated the effect of preoperative administration of a number of drugs to reduce endometrial thickness and achieve important intraoperative advantages. The purpose of this systematic review is to summarize the available evidence about the use of Dienogest, an orally administrable progestin, for endometrial preparation before hysteroscopic surgery.

All studies published on this topic and indexed on PubMed/MEDLINE, Embase or Google scholar databases were retrieved and analysed.

We retrieved five studies about this topic. Considered together, the published data analyses allow us to conclude that Dienogest is effective in reducing the thickness of the endometrium, the severity of bleeding and also of operative time, with a lower number of side effects compared with other pharmacological preparations or no treatment.

Administration of Dienogest may be an effective and safe treatment for endometrial thinning before operative hysteroscopy. However, this conclusion is based on few reports and further studies to prove or disprove it are warranted. Similar content being viewed by others

Di Spiezio Sardo A, Bettocchi S, Spinelli M et al (2010) Review of new office-based hysteroscopic procedures 2003–2009. J Minim Invasive Gynecol 17:436–448. doi:10.1016/j.jmig.2010.03.014 Gizzo S, Saccardi C, Di Gangi S et al (2014) Secondary amenorrhea in severe Asherman’s syndrome: step by step fertility retrieval by Bettocchi’s hysteroscope: some considerations. Minim Invasive Ther Allied Technol 23:115–119. doi:10.3109/13645706.2013.835736 Laganà AS, Ciancimino L, Mancuso A et al (2014) 3D sonohysterography vs hysteroscopy: a cross-sectional study for the evaluation of endouterine diseases. Arch Gynecol Obstet 290:1173–1178. doi:10.1007/s00404-014-3366-6 Sudano MC, Vitale SG, Rapisarda AMC et al (2015) The REP-b (removal of endometrial pathologies-basket) in-office hysteroscopy. Updates Surg. doi:10.1007/s13304-015-0294-3 Bradley LD (2002) Complications in hysteroscopy: prevention, treatment and legal risk. Curr Opin Obstet Gynecol 14:409–415. doi:10.1097/00001703-200208000-00008 Kayatas S, Meseci E, Tosun OA et al (2014) Experience of hysteroscopy indications and complications in 5, 474 cases. Clin Exp Obstet Gynecol 41:451–454. doi:10.12891/ceog17502014 Deffieux X, Gauthier T, Menager N et al (2013) Prevention of the complications related to hysteroscopy: guidelines for clinical practice. J Gynecol Obstet Biol Reprod (Paris) 42:1032–1049. doi:10.1016/j.jgyn.2013.09.008 Shveiky D, Rojansky N, Revel A et al (2007) Complications of hysteroscopic surgery: “Beyond the learning curve”. J Minim Invasive Gynecol 14:218–222. doi:10.1016/j.jmig.2006.07.019 Giacobbe V, Rossetti D, Vitale SG et al (2016) Otorrhagia and nosebleed as first signs of intravascular absorption syndrome during hysteroscopy: from bench to bedside. Kathmandu Univ Med J 14:87–89 Rai VS, Gillmer MDG, Gray W (2000) Is endometrial pre-treatment of value in improving the outcome of transcervical resection of the endometrium? Hum Reprod 15:1989–1992 Parazzini F, Vercellini P, De Giorgi O et al (1998) Efficacy of preoperative medical treatment in facilitating hysteroscopic endometrial resection, myomectomy and metroplasty: Literature review. Hum Reprod 13:2592–2597. doi:10.1093/humrep/13.9.2592 Florio P, Filippeschi M, Imperatore A et al (2012) The practicability and surgeons’ subjective experiences with vaginal danazol before an operative hysteroscopy. Steroids 77:528–533. doi:10.1016/j.steroids.2012.01.017 Cicinelli E, Pinto V, Tinelli R et al (2007) Rapid endometrial preparation for hysteroscopic surgery with oral desogestrel plus vaginal raloxifene: a prospective, randomized pilot study. Fertil Steril 88:698–701. doi:10.1016/j.fertnstert.2006.11.151 Bifulco G, Di Spiezio Sardo A, De Rosa N et al (2012) The use of an oral contraceptive containing estradiol valerate and dienogest before office operative hysteroscopy: a feasibility study. Gynecol Endocrinol 28:949–955. doi:10.3109/09513590.2012.683078 Tan YH, Lethaby A (2013) Pre-operative endometrial thinning agents before endometrial destruction for heavy menstrual bleeding. Cochrane Database Syst Rev. doi:10.1002/14651858.CD010241.pub2 Triolo O, De Vivo A, Benedetto V et al (2006) Gestrinone versus danazol as preoperative treatment for hysteroscopic surgery: a prospective, randomized evaluation. Fertil Steril 85:1027–1031. doi:10.1016/j.fertnstert.2005.09.034 Laganà AS, Palmara V, Granese R et al (2014) Desogestrel versus danazol as preoperative treatment for hysteroscopic surgery: a prospective, randomized evaluation. Gynecol Endocrinol 30:794–797. doi:10.3109/09513590.2014.929658 Shin D, Lee S, Lim KS et al (2013) Pharmacokinetic study of single and multiple oral administrations of 2 mg dienogest in healthy Korean women. Contraception 87:750–755. doi:10.1016/j.contraception.2012.10.033 Zeun S, Lu M, Uddin A et al (2009) Pharmacokinetics of an oral contraceptive containing oestradiol valerate and dienogest. Eur J Contracept Reprod Health Care 14:221–232. doi:10.1080/13625180902850039 Strowitzki T, Faustmann T, Gerlinger C et al (2015) Safety and tolerability of dienogest in endometriosis: pooled analysis from the European clinical study program. Int J Womens Health 7:393–401. doi:10.2147/IJWH.S77202 Mori T, Ito F, Matsushima H et al (2015) Dienogest reduces HSD17β1 expression and activity in endometriosis. J Endocrinol 225:69–76. doi:10.1530/JOE-15-0052 Sofo V, Götte M, Laganà AS et al (2015) Correlation between dioxin and endometriosis: an epigenetic route to unravel the pathogenesis of the disease. Arch Gynecol Obstet. doi:10.1007/s00404-015-3739-5 Miyashita M, Koga K, Takamura M et al (2014) Dienogest reduces proliferation, aromatase expression and angiogenesis, and increases apoptosis in human endometriosis. Gynecol Endocrinol 3590:1–5. doi:10.3109/09513590.2014.911279 Vetvicka V, Laganà AS, Salmeri FM et al (2016) Regulation of apoptotic pathways during endometriosis: from the molecular basis to the future perspectives. Arch Gynecol Obstet. doi:10.1007/s00404-016-4195-6 Laganà AS, Triolo O, Salmeri FM et al (2016) Natural Killer T cell subsets in eutopic and ectopic endometrium: a fresh look to a busy corner. Arch Gynecol Obstet 293:941–949. doi:10.1007/s00404-015-4004-7 Angioni S, Cofelice V, Pontis A et al (2014) New trends of progestins treatment of endometriosis. Gynecol Endocrinol 30:769–773. doi:10.3109/09513590.2014.950646 Bizzarri N, Remorgida V, Leone Roberti Maggiore U et al (2014) Dienogest in the treatment of endometriosis. Expert Opin Pharmacother 15:1889–1902. doi:10.1517/14656566.2014.943734 Maniglio P, Ricciardi E, Laganà AS et al (2016) Epigenetic modifications of primordial reproductive tract: a common etiologic pathway for Mayer–Rokitansky–Kuster–Hauser Syndrome and endometriosis? Med Hypotheses 90:4–5. doi:10.1016/j.mehy.2016.02.015 Petraglia F, Hornung D, Seitz C et al (2012) Reduced pelvic pain in women with endometriosis: efficacy of long-term Dienogest treatment. Arch Gynecol Obstet 285:167–173. doi:10.1007/s00404-011-1941-7 Triolo O, Laganà AS, Sturlese E (2013) Chronic pelvic pain in endometriosis: an overview. J Clin Med Res 5:153–163 Laganà AS, Vitale SG, Trovato MA et al (2016) Full-thickness excision versus shaving by laparoscopy for intestinal deep infiltrating endometriosis: rationale and potential treatment options. Biomed Res Int 2016:1–8. doi:10.1155/2016/3617179 White K, Potter JE, Hopkins K et al (2012) Contraindications to progestin-only oral contraceptive pills among reproductive-aged women. Contraception 86:199–203. doi:10.1016/j.contraception.2012.01.008 Hall KS, Trussell J, Schwarz EB (2012) Progestin-only contraceptive pill use among women in the United States. Contraception 86:653–658. doi:10.1016/j.contraception.2012.05.003 Sugimoto K, Nagata C, Hayashi H et al (2015) Use of dienogest over 53 weeks for the treatment of endometriosis. J Obstet Gynaecol Res 41:1921–1926. doi:10.1111/jog.12811 de Andres MP, Lopes LA, Baracat EC, Podgaec S (2015) Dienogest in the treatment of endometriosis: systematic review. Arch Gynecol Obstet 292:523–529. doi:10.1007/s00404-015-3681-6 Schindler AE (2011) Dienogest in long-term treatment of endometriosis. Int J Womens Health 3:175–184. doi:10.2147/IJWH.S5633 Laganà AS, Giacobbe V, Triolo O et al (2016) Dienogest as preoperative treatment of submucous myomas for hysteroscopic surgery: a prospective, randomized study. Gynecol Endocrinol 32:408–411. doi:10.3109/09513590.2015.1128409 Zorzela L, Loke YK, Ioannidis JP et al (2016) PRISMA harms checklist: improving harms reporting in systematic reviews. BMJ 352:i157. doi:10.1136/bmj.i157 Kodama M, Onoue M, Otsuka H et al (2013) Efficacy of Dienogest in thinning the endometrium before hysteroscopic surgery. J Minim Invasive Gynecol 20:790–795. doi:10.1016/j.jmig.2013.04.020 Cicinelli E, Pinto V, Quattromini P et al (2012) Endometrial preparation with estradiol plus Dienogest (Qlaira) for office hysteroscopic polypectomy: randomized pilot study. J Minim Invasive Gynecol 19:356–359. doi:10.1016/j.jmig.2011.12.020 Tsuchiya T, Katagiri Y, Maemura T et al (2016) Preoperative dienogest to improve the surgical field of view in resectoscopic surgery. Gynecol Minim Invasive Ther 5:16–19. doi:10.1016/j.gmit.2015.01.011 Banno K, Kisu I, Yanokura M et al (2012) Progestin therapy for endometrial cancer: the potential of fourth-generation progestin (Review). Int J Oncol 40:1755–1762. doi:10.3892/ijo.2012.1384 Saito F, Tashiro H, Yamaguchi M et al (2016) Development of a mouse model for testing therapeutic agents: the anticancer effect of dienogest on endometrial neoplasms. Gynecol Endocrinol 32:403–407. doi:10.3109/09513590.2015.1124411 Author information Authors and Affiliations Corresponding author Ethics declarations Funding The work was not supported by any Grant/fund. Conflict of interest The authors have no proprietary, financial, professional or other personal interest of any nature in any product, service or company. The authors alone are responsible for the content and writing of the paper. Ethical approval This article does not contain any studies with human participants or animals performed by any of the authors. Informed consent For this type of study formal consent is not required. Rights and permissions About this article Cite this article Laganà, A.S., Vitale, S.G., Muscia, V. et al. Endometrial preparation with Dienogest before hysteroscopic surgery: a systematic review. Arch Gynecol Obstet 295, 661–667 (2017). https://doi.org/10.1007/s00404-016-4244-1 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00404-016-4244-1