Comparative Efficacy of Dienogest and Cabergoline in Pain Relief and Size Reduction of Ovarian Endometriomas: A Prospective Study

ABSTRACT: Endometriosis‍‌‍‍‌‍‌‍‍‌ is a condition in which the growth of endometrial tissue occurs outside its typical location (most frequently the ovaries, where endometriomas form). This disease is the main reason for chronic pelvic pain and infertility in women of reproductive age. In this prospective comparative study, 50 women with ultrasound-detected ovarian endometriomas and pelvic pain were enrolled. They were randomly assigned to receive cabergoline 0.5 mg twice a week or dienogest 2 mg once a day for three months. The primary outcomes were changes in endometrioma size and pain scores. After the treatment, dienogest reduced the mean cyst diameter to a greater extent (around 19.7% compared to 8.77% with cabergoline), while cabergoline resulted in a slightly higher average reduction in visual analog scale pain scores (73% compared to 65% with dienogest), but this difference was not statistically significant. Both treatment regimens were generally well tolerated, with only mild and transient adverse effects reported. The results indicate that dienogest could be the drug of choice if the main therapeutic goal is to shrink the endometrioma, whereas cabergoline might be the drug of choice if pain relief and fertility preservation are prioritized. Therefore, larger and longer-term studies are needed to verify these ‍‌‍‍‌‍‌‍‍‌observations.