ASSESSMENT OF EFFICIENCY OF ANTI-RELAPSE THERAPY WITH DIENOGEST AFTER SURGERY TREATMENT OF WOMEN WITH COLORECTAL ENDOMETRIOSIS

E. V. Lisovskaya, Vladimir D. Chuprynin
In: Medical Council · 2018 · pp. 57–60 · doi:10.21518/2079-701x-2018-13-57-60 · W2893489056
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This study found that long-term dienogest monotherapy effectively prevented relapses of colorectal endometriosis after surgery, with good tolerability, though pregnancy rates were highest with shorter hormone therapy durations.

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This retrospective study evaluated reproductive outcomes and endometriosis recurrence in 51 women who underwent surgical treatment for colorectal endometriosis between 2014 and 2016, comparing postoperative strategies: dienogest 2 mg/day monotherapy, dienogest 2 mg plus ethinyl estradiol 0.03 mg combined oral contraception, or no hormonal therapy, with follow-up ranging from 12 to 48 months. No differences were found in the overall rate of pregnancy between groups, and most pregnancies (92.3%) occurred within the first year after surgery, suggesting possible influence of hormone-therapy duration on pregnancy likelihood. The lowest number of recurrences was reported in the group receiving long-term dienogest monotherapy, while that group also experienced more side effects, generally not causing substantial discomfort. The paper is centrally about endometriosis—specifically postoperative anti-relapse therapy with dienogest after surgery for colorectal endometriosis.

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Abstract

Purpose of research . To analyze reproductive outcomes and relapses of endometriosis in women after surgical treatment of colorectal endometriosis depending on hormonal therapy. Materials and methods . The article includes data on reproductive outcomes and recurrence of endometriosis in women undergoing surgical treatment for colorectal endometriosis in the surgical department of Kulakov National Medical Research Centre for Obstetrics, Gynaecology and Perinatology from 2014 to 2016. As an anti-relapse therapy, the first group of women received dienogest (DNG) at a dose of 2 mg/day, the second group included women who received a combined oral contraceptive containing DNG 2 mg + ethinyl estradiol (EE) 0.03 mg for the period of rehabilitation or prior to planning of pregnancy. The comparison group consisted of women who did not receive hormonal drugs in the postoperative period. Data on side effects and tolerability of the drug are also described. Results . During the follow up period from 12 to 48 months, 51 patients were selected for this study, 14 patients were included in the first group, 18 patients were in the second group, 19 patients were in the comparison group. There were no differences in the overall rate of pregnancy depending on the choice of tactics of postoperative management. The highest number of pregnancies (92.3%) occurred during the first year after surgery, which suggests the effect of the duration of hormone therapy on the probability of pregnancy. The lowest number of relapses was registered in the group of long-term monotherapy of DNG. In the group of DNG monotherapy a greater number of side effects were noted, which in most cases did not cause significant discomfort to patients. Conclusion . Long-term administration of DNG at a dose of 2 mg/day after surgical treatment of colorectal endometriosis is an effective means of preventing relapses with good tolerability. However, in some women planning a pregnancy, it may be rational to abandon hormone therapy in favor of earlier pregnancy planning.
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Оценка эффективности противорецидивной терапии диеногестом после оперативного лечения женщин с колоректальным эндометриозом https://doi.org/10.21518/2079-701X-2018-13-57-60 Аннотация Цель исследования. Провести анализ репродуктивных исходов и рецидивов эндометриоза у женщин после оперативного лечения колоректального эндометриоза в зависимости от проводимой гормональной терапии. Материалы и методы. В статью включены данные о репродуктивных исходах и рецидивах эндометриоза у женщин, проходивших оперативное лечение по поводу колоректального эндометриоза в хирургическом отделении НМИЦ АГП им. В.И. Кулакова с 2014 по 2016 г. В качестве противорецидивной терапии первой группе женщин был назначен диеногест (ДНГ) в дозировке 2 мг/сут, во вторую группу были включены женщины, которым с целью контрацепции на период реабилитации или до планирования беременности был назначен комбинированный оральный контрацептив, содержащий ДНГ 2 мг + этинилэстрадиол (ЭЭ) 0,03 мг. Группу сравнения составили женщины, не получавшие гормональные препараты в послеоперационном периоде. Также описаны данные о побочных эффектах и переносимости препарата. Результаты. За период наблюдения от 12 до 48 месяцев в данное исследование была отобрана 51 пациентка, из них в первую группу было включено 14 пациенток, во вторую группу – 18 пациенток, группу сравнения составили 19 пациенток. Не было выявлено различий в общей частоте наступления беременности в зависимости от выбора тактики послеоперационного ведения. При этом наибольшее число беременностей (92,3%) наступило в течение первого года после операции, что позволяет предположить влияние длительности проводимой гормональной терапии на вероятность наступления беременности. Наименьшее число рецидивов заболевания было зарегистрировано в группе длительной монотерапии ДНГ. В группе монотерапии ДНГ было отмечено большее число побочных эффектов, которые в большинстве случаев не доставляли существенного дискомфорта пациенткам. Заключение. Длительный прием ДНГ в дозировке 2 мг/сут после оперативного лечения колоректального эндометриоза является эффективным средством профилактики рецидивов с хорошей переносимостью. Однако у некоторых женщин, планирующих беременность, рациональным может оказаться отказ от гормонотерапии в пользу более раннего планирования беременности. Об авторах Е. В. ЛисовскаяРоссия врач акушер-гинеколог, аспирант хирургического отделения В. Д. Чупрынин Россия к.м.н., зав. хирургическим отделением, руководитель хирургического отдела Список литературы 1. Эндометриоз: диагностика, лечение и реабилитация. Федеральные клинические рекомендации по ведению больных. Под ред. Л.В. Адамян (проект), 2013. 2. Chapron C, Dubuisson JB, Fritel X, et al. Operative management of deep endometriosis infiltrating the uterosacral ligaments. J Am Assoc Gynecol Laparosc, 1999, 6(1): 31-7. 3. Mabrouk M, Spagnolo E, Raimondo D, Derrico A, Caprara G, Malvi D, Catena F, Ferrini G, Paradisi R, and Seracchioli R. Segmental bowel resection for colorectal endometriosis: Is there a correlation between histological pattern and clinical outcomes? Hum Reprod, 2012, 27(5): 1314–1319. 4. Brown J, Farquhar C. Endometriosis: an overview of Cochrane Reviews. Cochrane Database Syst Rev, 2014, 3. 5. Casper RF. Progestin-only pills may be a better first-line treatment for endometriosis than combined estrogen-progestin contraceptive pills. Fertil Steril, 2017, 107: 533–6. 6. Koshiba A, Mori T, Okimura H et al. Dienogest therapy during the early stages of recurrence of endometrioma might be an alternative therapeutic option to avoid repeat surgeries. J Obstet Gynaecol Res, 2018. 7. Lee JH, Song JY, Yi KW et al. Effectiveness of Dienogest for Treatment of Recurrent Endometriosis: Multicenter Data. Reprod Sci, 2018. 8. Chandra A, Rho AM, Jeong K et all. Clinical experience of long-term use of dienogest after surgery for ovarian endometrioma. Obstet Gynecol Sci, 2018, 61(1): 111-117. 9. Andreas D. Ebert Daily Vaginal Application of Dienogest (Visanne,) for 3 Months in Symptomatic Deeply Infiltrating Rectovaginal Endometriosis: A Possible New Treatment Approach? Case Rep Obstet Gynecol, 2018. Рецензия Для цитирования: Лисовская ЕВ, Чупрынин ВД. Оценка эффективности противорецидивной терапии диеногестом после оперативного лечения женщин с колоректальным эндометриозом. Медицинский Совет. 2018;(13):57-60. https://doi.org/10.21518/2079-701X-2018-13-57-60 For citation: Lisovskaya EV, Chuprynin VD. ASSESSMENT OF EFFICIENCY OF ANTI-RELAPSE THERAPY WITH DIENOGEST AFTER SURGERY TREATMENT OF WOMEN WITH COLORECTAL ENDOMETRIOSIS. Meditsinskiy sovet = Medical Council. 2018;(13):57-60. (In Russ.) https://doi.org/10.21518/2079-701X-2018-13-57-60 JATS XML

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