Long-Term Administration of Dienogest Reduces Recurrence after Excision of Endometrioma

Yoshiaki Ota, Masaaki Andou, Shiori Yanai, S. Nakajima, Mika Fukuda, M. Takano, Shozo Kurotsuchi, K. Ebisawa, Tomonori Hada, Ikuko Ota
In: Journal of Endometriosis and Pelvic Pain Disorders · 2015 · vol. 7(2) , pp. 63–67 · doi:10.5301/je.5000219 · W2218918216
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Long-term dienogest administration significantly reduced endometrioma recurrence to 4% over 5 years compared to 69% without medication, despite side effects like metrorrhagia and decreased bone density.

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Abstract

Background Pain-relieving effects of dienogest against endometriosis are comparable to leuprolide acetate for 24 weeks. We assessed whether long-term dienogest administration reduces recurrence after endometrioma excision. Methods In this retrospective cohort study, 568 women with MRI-based diagnosis of ovarian endometrioma, who underwent laparoscopic stripping between 2008 and 2013, were studied. Recurrence rates and side effects over 5 years were investigated in 417 without postoperative medication and 151 who received dienogest postoperatively at 2 mg. Transvaginal sonography was performed every 3 months, and when cystic lesions ≥2 cm were observed, diagnostic MRI was conducted. Recurrence was defined as a lesion previously diagnosed as endometrioma by MRI, equal in size or larger 3 months later on ultrasonography. Cumulative recurrence rates were calculated with the Kaplan-Meier method, and group comparison involved log-rank tests. Blood examinations were completed every 3 months, and bone mineral density was measured with DEXA every 6 months. Results Cumulative recurrence rates at the 5th postoperative year in the no-postoperative-medication and 2-mg dienogest groups were 69 and 4%, respectively, showing significant decreases (odd ratio [OR] = 0.09, 95% confidence interval, 0.03-0.26). Anemia occurred in 4% due to metrorrhagia directly after administration, metrorrhagia including spotting was observed in 20% at 1 year and decreases in bone mineral density and depression were observed in 4 and 2.6%, respectively, in the dienogest group. Conclusions Dienogest significantly prevented postoperative endometrioma recurrence. However, side effects such as metrorrhagia and a decreased bone mineral density were observed. Therefore, careful long-term follow-up is necessary.

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endometriosisendometrioma

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