Dienogest alone or dienogest combined with estrogens in the treatment of ovarian endometriomas, that is the question. A retrospective cohort study

Simona Del Forno, Benedetta Orsini, Ludovica Verrelli, Martina Caroli, Anna Chiara Aru, Jacopo Lenzi, Diego Raimondo, Alessandro Arena, Giulia Borghese, Roberto Paradisi, Maria Cristina Meriggiola, Renato Seracchioli, Paolo Casadio
Archives of gynecology and obstetrics · 2023 · vol. 308(4) , pp. 1341–1349 · doi:10.1007/s00404-023-07125-2 · PMID:37433947 · W4383893254
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

Dienogest alone or with estrogens showed similar effectiveness in reducing ovarian endometrioma size, but dienogest alone better reduced dysmenorrhea while combined therapy improved dysuria more.

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

This retrospective cohort study evaluated 297 reproductive-age symptomatic women with ultrasound-diagnosed ovarian endometriomas treated for at least 12 months with dienogest 2 mg alone (D) or dienogest combined with ethinylestradiol (D+EE) or estradiol valerate (D+EV), assessing endometrioma size and pain-related symptoms at baseline, 6 months, and 12 months. Across all groups, medical therapy produced a significant reduction in mean endometrioma diameter after 12 months with no difference in lesion size change between regimens; however, dysmenorrhea decreased more in the D-alone group, while dysuria improved more in the combined estrogen groups, and side effects occurred in 16.2% with bleeding/spotting significantly higher in D+EV. The authors note the study is retrospective and based on clinical-record data, with outcomes depending on ultrasound “pattern recognition” and symptom reporting. This paper is centrally about endometriosis — it compares dienogest alone versus dienogest plus estrogens for symptoms and ovarian endometrioma size reduction in women with ovarian endometriosis.

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Abstract

PURPOSE: to compare the effects of Dienogest 2 mg (D) alone or combined with estrogens (D + ethinylestradiol 0.03 mg, D + EE; D + estradiol valerate 1-3 mg, D + EV) in terms of symptoms and endometriotic lesions variations. METHODS: This retrospective study included symptomatic patients in reproductive age with ultrasound diagnosis of ovarian endometriomas. Medical therapy for at least 12 months with D, D + EE or D + EV was required. Women were evaluated at baseline visit (V1) and after 6 (V2) and 12 months (V3) of therapy. RESULTS: 297 patients were enrolled (156 in the D group, 58 in the D + EE group, 83 in the D + EV group). Medical treatment leaded to a significant reduction in size of endometriomas after 12 months, with no differences between the three groups. When comparing D and D + EE/D + EV groups, a significant decrease of dysmenorrhea was detected in the D group than in D + EE/D + EV group. Conversely, the reduction of dysuria was more significative in the D + EE/D + EV groups rather than in the D group. Regarding tolerability, treatment associated side effects were reported by 16.2% patients. The most frequent one was uterine bleeding/spotting, significantly higher in the D + EV group. CONCLUSION: Dienogest alone or associated with estrogens (EE/EV) seems to be equally effective in reducing endometriotic lesions mean diameter. The reduction of dysmenorrhea was more significative when D was administered alone, while dysuria seems to improve more when D is associated with estrogens.

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Condition tags

mesh:D004412mesh:D004715dysmenorrhea

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Nandrolone Nandrolone Nandrolone Nandrolone Nandrolone

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