To evaluate the effectiveness of dienogest in controlling bleeding abnormalities in endometriosis

Background & Method: The present study was carried out in outdoor and indoor patients with an aim to “To e valuate the effectiveness of dienogest in controlling bleeding abnormalities in endometriosis” was conducted in the Department of Obstetrics and Gynaecology, Sri Aurobindo Medical College & P.G. Institute, Indore M.P. Women with endometriosis and presence of at least one of the symptoms were included in the study. Study was done according to the regulations of the Institutional Ethics Committee. Detailed history was taken, general and gynaeco logical examinations were done. According to patient’s symptoms VAS and PLAB Scoring was done Either USG, MRI or if needed Laparoscopy was done.

The distribution of patients based on Symptoms of Endometriosis. An equal percentage of patients i.e. 40% had CPP (Chronic Pelvic Pain)+ Dysmenorrhea and CPP + Dysmenorr hea+ Heavy Menses followed by 10% who were having CPP + Dyspareunia + Dysmenorrhea, 8% had CPP+ infertility while, the lowest percentage 2% had CPP+ infertility+ Heavy Bleeding. The distribution of patients based on their PT Satisfaction Score. The highest percentage of patients i.e. 50% were Very Satisfied followed by 30% who were Satisfied while, the lowest percentage 14% were Not Satisfied.

Endometriosis is a disease that requires a drawn out administration. Dienogest is by all accounts compe lling for the treatment of agony and draining irregularities, related with endometriosis. Taking everything into account our information shows that dienogest could further develop wellbeing related personal satisfaction of lady and diminishes in the view o f endometriosis related torment and substantial dying. In our examination 30% ladies have Adenomyosis as an accompanying disease and 24 % ladies were has previous history of Adenomyosis.

Dienogest, bleeding abnormalities & endometriosis

The presence of endometrial glands and tissue outside the uterus is called Endometrium. Endometrioma is known as an endometrioid cyst [1]. Endometrioid cysts, often filled with dark, reddish-brown blood, may range in size from 0.75-8 inches. Endometriomas arise when an ovarian surface deposit of endometriosis adheres to another structure, usua lly the broad ligament. The cyst then grows from trapped menstruation by progressively invaginating the whole ovarian cort ex (cortical invagination cyst) [2]. From the surgeon’s point of view, this process is most likely, because the majority of Endometriomas adhere to the peritoneum where rupture of the cysts almost always occurs during adhesiolysis. Metaplasia of mesothelium lining the surface inclusion cyst [3] and colonization of preexisting hemorrhagic corpus luteal cysts is caused by endometritis tissue [4]. Additional theories for the formation of Endometrioma, the possibility of intra -parenchymal endometritis deposits generating an ovarian endometritis cyst [5].

& method The present study was carried out in outdoor and indoor patients with an aim to “To evaluate the effectiveness of dienogest in controlling bleeding abnormalities in endometriosis” was conducted in the Department of Obstetrics and Gynaecology, Sri Aurobindo Medical College & P.G. Institute, Indore M.P. from Sept 2016 to Sep 2018, total 100 patients. Women with endometriosis and presence of at least one of the symptoms were included in the study. Study was done according to the regulations of the Institutional Ethics Committee. • Detailed history was taken, general and gynaecological examinations were done. • According to patient’s symptoms VAS and PLAB Scoring was done International Journal of Clinical Obstetrics and Gynaecology http://www.gynaecologyjournal.com ~ 241 ~ • Either USG, MRI or if needed Laparoscopy was done Inclusion criteria • Women in the reproductive age group18-45 years • Women with endometriosis and presence of at least one of the symptoms dysmenorrhea, infertility, chronic pelvic pain, dyspareunia • Woman who give consent. Exclusion criteria • Women with congenital or acquired uterine anomaly. • Women with genital bleeding of unknown etiology. • Women with other medical disorder like thyroid and bleeding disorder • Women with liver and heart disease. • Women who had undergone a therapeutic surgical procedure in past 6 months. • Women with pregnancy as well as those with a desire immediate pregnancy.

Table 1: Distribution of cases based on history (h/o) of endometriosis H/O of Endometriosis No. of Cases % No 76 76 Yes 24 24 Total 100 100 The distribution of patients based on History of Endometriosis. The higher percentage of patients i.e. 76% were not having History of Endometriosis while, 24% were having it. Table 2: Distribution of case based on symptoms of endometriosis Symptoms No. of Cases % CPP + Dysmenorrhea 40 40 CPP + Dysmenorrhea + Heavy Menses 40 40 CPP + Dyspareunia + Dysmenorrhea 10 10 CPP+ Infertility 8 8 CPP+ Infertility + Heavy Bleeding 2 2 Total 100 100 The distribution of patients based on Symptoms of Endometriosis. An equal percentage of patients i.e. 40% had CPP (Chronic Pelvic pain) + Dysmenorrhea and CPP + Dysmenorrhea + Heavy Menses followed by 10% who were having CPP + Dyspareunia + Dysmenorrhea, 8% had CPP + infertility while, the lowest percentage 2% had CPP+ infertility + Heavy Bleeding. Table 3: Distribution based on the base of diagnosis laparoscopic findings Laparoscopic Findings No. of Cases % Superficial Deposit 14 14 Adhesion+ Hydrosalpinx 2 2 Adhesion 12 12 Deep Endometriosis 2 2 Not Done 70 70 Total 100 100 The di stribution of patients based on their Laparoscopic Findings. The highest percentage of patients i.e. 14% had Superficial Deposit followed by 12% who were having Adhesion while, an equal percentage 2% had Adhesion+ Hydrosalpinx and deep Endometriosis. Table 4: Distribution of case Based on PT Satisfaction Score PT Satisfaction Score No. of Cases % Not satisfied (0-3) 14 14 Satisfied (4 to7 ) 30 30 Very satisfied (8 -10) 50 50 Total 100 100 The distribution of patients based on their PT Satisfaction Sc ore. The highest percentage of patients i.e. 50% were Very Satisfied followed by 30% who were Satisfied while, the lowest percentage 14% were Not Satisfied.

In our examination 24% were having endometriosis. Then again Techatraisak K et al . [7] (2019) all patients 864/864 100% patients had history of endometriosis. In the examination Caruso S. et al. [8] (2018) most normal manifestation was constant pelvic torment in 100% (n=51) ladies, dysmenorrhea n=50 (78.4%) and Dyspareunia n=38 (74.5%). In our examination practically same outcomes were found. Most normal manifestation of endometriosis was constant pelvic torment (100%), dysmenorrheal (half) and 42% ladies who gave substantial bleeding [6]. Just 10% ladies had fruitlessness. In equivalent per cent of patients(40%) had Chronic pelvic pain(CPP)+dysmenorrhea and CPP + Dysmenorrhea + heavy menses followed by 10% who were having CPP + Dyspareunia + dysmenorrhea. 8% had CPP + infertility while the lower percent 2% had CPP + infertility + heavy menses. In the investigation Techatraisak K et al. [7] (2019) most normal side effect of endometrio sis was dysmenorrhea (n=684/865 ; 79.1%) and constant pelvic agony (n=279/865; 32.3%), Dyspareunia (5.9%). In the examination Techatraisak K et al . [7] (2019) N=616(71.2%) ladies were analyzed precisely or laparoscopically and n=247 (28.6%) were analyzed clinically. 0.2% were missing [9]. The determination of endometriosis depends on clinical history, assessment and imaging. In our examination n=15 (30%) of ladies were analyzed laparoscopically and by USG (TAS/TVS) n=35 (70%) were analyzed.

Endometriosis is a disease that requires a drawn out administration. Dienogest is by all accounts compelling for the treatment of agony and draining irregularities, related with endometriosis. Taking everything into account our information shows that dienogest could further develop wellbeing related personal satisfaction of lady and diminishes in the view of endometriosis related torment and substantial dying. In our examination 30% ladies have Adenomyosis as an accompanying disease and 24 % ladies were has previous history of Adenomyosis.

1. Schindler AE. Dienogest in long -term treatment of endometriosis, Int J Womens Health. 2011;3:175–184. 2. Scurry J, Whiteh ead J, Healey M. Classification of ovarian Endometriotic Cysts, Int J Gynecol Pathol. 2001;20:147 – 154. 3. Donnez J, Nisolle M, Gillet N, et al. Large ovarian Endometriomas Hum Reprod. 1996;11:641–646. 4. Nezhat F, Nezhat C, Allan CJ, et al. Clinical and histolog ic classification of Endometriomas implications for a mechanism of pathogenesis , J Reprod Med. 1992;37:771 – 776. International Journal of Clinical Obstetrics and Gynaecology http://www.gynaecologyjournal.com ~ 242 ~ 5. Michele Vignali, Gaia Maria Belloni, Giuliana Pietropaolo, Allegra Barbasetti Di Prun, Valeria Barbera, Stefano Angioni & Ida Pino, 2020. 6. Effect of Dienogest therapy on the size of the Endometrioma, Gynecological Endocrinology. DOI: 10.1080/09513590.2020.1725965 7. Barra F, Scala C. Maggiore LR and Ferrero S. Long ‐Term Administration of Dienogest for the Treatment of Pain and Intestinal Symptoms in P atients with Recto sigmoid Endometriosis J. Clin Med. 2020;9:154. DOI: 10.3390/jcm9010154. 8. Techatraisak K, Hestiantoro A, Ruey S, Banal -Silao MJ, Kim MR, Seong SJ , et al. Effectiveness of dienogest in improving quality of life in Asian women with endometriosis ( ENVISIOEN): Interim results from a prospective cohort study under real life clinical practice BMC Women's Health. 2019;19:68. https://doi.org/10.1186/s12905-019-0758-6. 9. Caruso S, Iraci M, Cianci S, Fava V, Casella E, Cianci A. Effects of long-term treatment with Dienogest on the quality of life and sexual function of women affected by endometriosis-associated pelvic pain, Journal of Pain Research. 2019; 12:2371-2378. DOI: 10.2147/JPR.S207599. 10. Shabina Khan, Sweety Raj, Shreshu Yadav. Safety and efficacy of dienogest in long t erm treatment of endometriosis, International Journal of contemporary medical research. 2019;6(9):I1-I4. DOI: http://dx.doi.org/10.21276/ijcmr.2019.6.9.35