Efficacy of dienogest in the treatment of endometrioma-related pain and subfertility

AIM: This study evaluates the efficacy and safety of Dienogest in the treatment of endometrioma and related symptoms. METHODS: This study included 209 patients who were diagnosed with endometrioma in our clinic between January 1, 2010, and December 31, 2021. The patients were diagnosed with ultrasonography by using the ultrasonographic diagnostic criteria of endometrioma. These diagnostic criteria were supported by clinical findings. Demographic characteristics, medical history, ultrasonographic examination of endometrioma, and the pre-treatment visual analog scale (VAS) assessment score of all patients were recorded in the study. The female sexual function index (FSFI) was used to assess sexual function before and during treatment, and the results were recorded. Patients received dienogest (2 mg/day) for 18 months. Ultrasonography was performed from the beginning of treatment until the 18th month every 3 months, blood values were monitored, and VAS scores were recorded. A total of 182 patients out of 209 patients completed the 18-month treatment. Four different statistical analyses were used to evaluate the data of the patients who completed the treatment, and these analyses were performed with SPSS 22.00 statistical package program. RESULTS: A total of 182 patients completed the 18-month study. Endometrioma volume was statistically significantly (84.3%) reduced during the treatment period (P < 0.001). Similarly, the pain of the patients also decreased significantly (P < 0.001). In addition, CA-125 values were decreased in parallel with the endometrioma volume. All VAS scores and FSFI scores were significantly improved during the treatment period. Antral follicle count and anti-Müllerian hormone value, which are markers of ovarian reserve, were significantly increased. During the 6-month follow-up period after the completion of treatment, eight (44.4%) of 18 patients with infertility before treatment became spontaneously pregnant. Hgb, WBC, plt, FSH, LH, E2, liver function tests, and lipid profiles did not change. CONCLUSION: Eighteen months of dienogest treatment was highly effective, safe, and tolerable in reducing endometrioma-related pelvic pain, improving sexual dysfunction due to endometrioma, volume of endometrioma, and markers of ovarian reserve. In conclusion, dienogest can be used in infertile patients before surgery or oocyte retrieval to reduce the risk of abscesses and infections. Long-term dienogest treatment in young women with no desire for pregnancy in the short term might reduce the likelihood of surgery later in life and the risk of loss of ovarian reserve due to repeated surgery, while increasing the likelihood of fertilization.