Efficacy and Tolerability of Short-Term Hormonal Therapy Following Conservative Surgery for Endometriosis

Yuli Trisetiyono, Razmaeda Sarastry, Julian Dewantiningrum, Arufiadi Anityo Mochtar, Herman Yosep Wisnu Kristanto, Syarief Thaufik Hidayat
In: Indonesian Journal of Obstetrics and Gynecology · 2025 · pp. 278–284 · doi:10.32771/inajog.v13i4.2588 · W7117540933
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-08-02 ⓘ

Short-term postoperative hormonal therapies (Dienogest, DMPA, COC, LA) effectively reduced endometriosis pain and inflammatory markers, with progestin-based options showing comparable efficacy and better tolerability than GnRH agonists.

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This randomized, prospective study evaluated the efficacy and tolerability of four short-term hormonal therapies—Dienogest, Depot Medroxyprogesterone Acetate, continuous Combined Oral Contraceptives, and Leuprolide Acetate—in women with surgically confirmed endometriosis. Participants received their assigned treatment for twelve weeks post-surgery, with primary outcomes measuring changes in pain intensity via visual analog scale, estradiol levels, inflammatory markers, and tolerability using the Menopause Rating Scale. The results demonstrated that all four regimens significantly reduced dysmenorrhea, dyspareunia, and chronic pelvic pain while lowering estradiol and TNF-alpha levels, with no statistically significant differences in clinical efficacy among the groups. Although Leuprolide caused transient increases in menopausal symptoms, progestin-based therapies offered comparable pain relief to GnRH agonists with better overall tolerability profiles over the short term. This paper is centrally about endometriosis — specifically comparing postoperative hormonal management strategies for endometriosis-associated pain.

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Abstract

AbstractObjective: To compare the efficacy and tolerability of four short-term hormonal therapies; Dienogest (DNG), Depot Medroxyprogesterone Acetate (DMPA), continuous Combined Oral Contraceptive (COC), and Leuprolide Acetate (LA); administered for 12 weeks after conservative endometriosis surgery. Methods: This randomized, prospective, open-label study enrolled reproductive-aged women with surgically confirmed endometriosis. Participants were randomly assigned to receive DNG 2 mg daily, DMPA 150 mg intramuscularly every 12 weeks, continuous COC (ethinyl estradiol 0.03 mg and levonogestrel 0.15 mg) daily, or LA 3.75 mg intramuscularly every 4 weeks. Primary outcomes were changes in pain intensity (visual analog scale, VAS), hormonal markers (estradiol, E2), inflammatory markers (TNF-?), and the Menopause Rating Scale (MRS) as an indicator of tolerability. Data were analyzed using ANOVA with a significance level of p < 0.05. Results: All four regimens resulted in significant reductions in dysmenorrhea, dyspareunia, and chronic pelvic pain after 12 weeks (p < 0.001). E2 and TNF-? levels decreased significantly in all groups, with the greatest decline observed in the LA arm. No significant differences were found among regimens in pain reduction or biomarker changes (p > 0.05). MRS scores increased transiently at week 8, particularly in the LA group, reflecting hypoestrogenic effects, but decreased by week 12 in all groups. Conclusion: Short-term postoperative hormonal therapy with DNG, DMPA, COC, or LA effectively reduces pain and inflammatory markers following endometriosis surgery. Progestin-based therapies achieve comparable clinical efficacy to GnRH agonists with superior tolerability. Individualized selection based on symptom profile, side effects, and accessibility is recommended in accordance with ESHRE guidelines. Keywords: endometriosis-associated pain, Menopause Rating Scale, short-term hormonal therapy.
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Abstract

Objective: To compare the efficacy and tolerability of four short-term hormonal therapies; Dienogest (DNG), Depot Medroxyprogesterone Acetate (DMPA), continuous Combined Oral Contraceptive (COC), and Leuprolide Acetate (LA); administered for 12 weeks after conservative endometriosis surgery.

Methods

This randomized, prospective, open-label study enrolled reproductive-aged women with surgically confirmed endometriosis. Participants were randomly assigned to receive DNG 2 mg daily, DMPA 150 mg intramuscularly every 12 weeks, continuous COC (ethinyl estradiol 0.03 mg and levonogestrel 0.15 mg) daily, or LA 3.75 mg intramuscularly every 4 weeks. Primary outcomes were changes in pain intensity (visual analog scale, VAS), hormonal markers (estradiol, E2), inflammatory markers (TNF-?), and the Menopause Rating Scale (MRS) as an indicator of tolerability. Data were analyzed using ANOVA with a significance level of p < 0.05.

Results

All four regimens resulted in significant reductions in dysmenorrhea, dyspareunia, and chronic pelvic pain after 12 weeks (p < 0.001). E2 and TNF-? levels decreased significantly in all groups, with the greatest decline observed in the LA arm. No significant differences were found among regimens in pain reduction or biomarker changes (p > 0.05). MRS scores increased transiently at week 8, particularly in the LA group, reflecting hypoestrogenic effects, but decreased by week 12 in all groups.

Conclusion

Short-term postoperative hormonal therapy with DNG, DMPA, COC, or LA effectively reduces pain and inflammatory markers following endometriosis surgery. Progestin-based therapies achieve comparable clinical efficacy to GnRH agonists with superior tolerability. Individualized selection based on symptom profile, side effects, and accessibility is recommended in accordance with ESHRE guidelines.

Keywords

endometriosis-associated pain, Menopause Rating Scale, short-term hormonal therapy.

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VAS-pain

Condition tags

endometriosischronic_pelvic_paindysmenorrheadyspareunia

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