Impact of dienogest therapy on CA125 levels, hormonal profile, and systemic inflammatory indices in endometriosis
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Abstract
Aims: The present study aims to evaluate the impact of dienogest therapy on CA125 levels, hormonal profile, and systemic inflammatory indices in patients with endometriosis, a chronic inflammatory disorder in which inflammation constitutes a fundamental component of the pathophysiology. Methods: This retrospective, pre–post analytical study included 150 female with endometriosis who received dienogest. Demographic and laboratory data were obtained from electronic medical records. Systemic inflammatory indices including neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), neutrophil-to-monocyte ratio (NMR), plateletto-lymphocyte ratio (PLR), mean platelet volume (MPV), MPV-to-lymphocyte ratio (MPVLR), cancer antigen 125 (CA-125), Systemic Immune-inflammation Index (SII), Systemic Inflammation Response Index (SIRI), and pan-immune-inflammation value (PIV) were evaluated before and after treatment. Statistical analyses were performed using appropriate parametric and nonparametric tests, and correlation analyses were conducted. Results: Following dienogest therapy, statistically significant reductions were observed in CA125 levels (p=0.010) and PLR (p=0.028), along with decreases in leukocyte, and PCT levels. FSH levels showed a significant increase (p=0.001), whereas LH, estradiol, progesterone, TSH, FT3, and FT4 levels remained unchanged (p>0.05 for all). Significant increases were also noted in hemoglobin, hematocrit, MCV, and MCH values after treatment (p<0.05). No statistically significant differences were detected in NLR, MLR, NMR, MPVLR, SII, SIRI, or PIV. Correlation analyses demonstrated a positive association between CA 125 and PLR, as well as inverse correlations between CA125 and hematocrit. Conclusion: Dienogest therapy was associated with a reduction in CA125 levels and specific inflammatory markers, alongside improvements in certain hematological parameters in patients with endometriosis. These findings suggest a potential antiinflammatory benefit, indicating that dienogest may be involved in the modulation of systemic inflammatory burden. Furthermore, the preservation of endocrine homeostasis may support its favorable safety profile as an effective therapeutic option in the management of endometriosis.
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Abstract
1. Dai Y, Ye Z, Lin X, Zhang S. Immunopathological insights into endometriosis: from research advances to future treatments. Semin Immunopathol. 2025;47(1):31. doi:10.1007/s00281-025-01058-5
2. Giudice LC, Kao LC. Endometriosis. Lancet. 2004;364(9447):1789-1799. doi:10.1016/S0140-6736(04)17403-5
3. Parasar P, Ozcan P, Terry KL. Endometriosis: epidemiology, diagnosis and clinical management. Curr Obstet Gynecol Rep. 2017;6(1):34-41. doi: 10.1007/s13669-017-0187-1
4. Farland LV, Shah DK, Kvaskoff M, Zondervan KT, Missmer SA. Epidemiological and clinical risk factors for endometriosis. In: D’Hooghe T, ed. Biomarkers for Endometriosis. Springer International Publishing; 2017:95-121. doi:10.1007/978-3-319-59856-7_6
5. McKinnon BD, Kocbek V, Nirgianakis K, Bersinger NA, Mueller MD. Kinase signalling pathways in endometriosis: potential targets for non-hormonal therapeutics. Hum Reprod Update. 2016;22(3):382-403. doi: 10.1093/humupd/dmv060
6. Yarmolinskaya MI, Andreeva EN, Bezhenar VF, Popov AA, Cherkashina SA. Efficacy and safety endpoints of dienogest treatment of endometriosis: a systematic review. J Obstet Women’s Dis. 2025;74(4):86-103. doi:10.17816/JOWD689557
7. Kim HJ, Kim SH, Oh YS, Lee SR, Chae HD. Dienogest may reduce estradiol-and inflammatory cytokine-induced cell viability and proliferation and inhibit the pathogenesis of endometriosis: a cell culture-and mouse model-based study. Biomedicines. 2022;10(11):2992.
8. Ichioka M, Mita S, Shimizu Y, et al. Dienogest, a synthetic progestin, down-regulates expression of CYP19A1 and inflammatory and neuroangiogenesis factors through progesterone receptor isoforms A and B in endometriotic cells. J Steroid Biochemistry Mol Biol. 2015;147: 103-110. doi:10.1016/j.jsbmb.2014.12.008
9. Arıkan FB, Öztürk H. Inflammatory indices in hypertensive hemodialysis patients: clinical implications of MPV and MPVLR. J Med Palliat Care. 2025;6(5):569-574. doi:10.47582/jompac.1773774
10. Arıkan FB, Sağsöz N. Enhancing diagnostic accuracy in polycystic ovary syndrome using novel inflammatory indices. J Kırıkkale Univ Faculty Med. 2025;27(2):217-224.
11. Kurt DS, Akay A, Ulusoy CO, Kurt A, Karabay G, Keskin HL. Evaluation of serum-based inflammatory and haematological markers in patients with endometriosis: a case-control study. Eur J Obstet Gynecol Reproductive Biol. 2025;315:114751. doi:10.1016/j.ejogrb.2025.114751
12. Duan YN, Peng YQ, Xu X, Shi XL, Peng CX. Positive correlation between NLR and PLR in 10,458 patients with endometriosis in reproductive age in China. Eur Rev Med Pharmacological Sci. 2023;27(5):2002-2010. doi: 10.26355/eurrev_202303_31566
13. Seckin B, Ates MC, Kirbas A, Yesilyurt H. Usefulness of hematological parameters for differential diagnosis of endometriomas in adolescents/young adults and older women. Int J Adolescent Med Health. 2021;33(2): 20180078. doi:10.1515/ijamh-2018-0078
14. Chung YS, Shim JE, Baek JK, et al. Gene expression profiling and pathway analysis of the effect of dienogest on ovarian endometriosis: a comparative study. Yonsei Med J. 2025;66(11):780. doi:10.3349/ymj. 2024.0518
15. Momenimovahed Z, Mazidimoradi A, Allahqoli L, Salehiniya H. The role of CA-125 in the management of ovarian cancer: a systematic review. Cancer Reports. 2025;8(3):e70142. doi:10.1002/cnr2.70142
16. Atlihan U, Yavuz O, Ata C, Avsar HA, Erkilinc S. Effects of dienogest treatment on endometrioma-related clinical symptoms and endometrioma size: retrospective cohort study. Front Med. 2025;12: 1581661. doi:10.3389/fmed.2025.1581661
17. Lu BJ, Chen CH. Dienogest as a feasible alternative for luteinizing hormone suppression in progestin-primed ovarian stimulation. Fert Sterility. 2023;120(4):e71. doi:10.1016/j.fertnstert.2023.08.220
18. McCormack PL. Dienogest: a review of its use in the treatment of endometriosis. Drugs. 2010;70(16):2073-2088. doi:10.2165/11206320-000000000-00000
19. Simpson PD, McLaren JS, Rymer J, Morris EP. Minimising menopausal side effects whilst treating endometriosis and fibroids. Post Reprod Health. 2015;21(1):16-23. doi:10.1177/2053369114568440
20. Murta I, Bicca J, Cardoso N. MON-196 hormone replacement therapy in menopausal patient with symptomatic endometriosis and bone metabolism: a case report. J Endocrine Soc. 2025;9(Supplement_1):bvaf 149.1927. doi:10.1210/jendso/bvaf149.1927
21. Guo K, Lu J, Yu H, et al. Serum betatrophin concentrations are significantly increased in overweight but not in obese or type 2 diabetic individuals. Obesity. 2015;23(4):793-797. doi:10.1002/oby.21038
22. Gete DG, Doust J, Mortlock S, Montgomery G, Mishra GD. Risk of iron deficiency in women with endometriosis: a population-based prospective cohort study. Women’s Health Issues. 2024;34(3):317-324. doi:10.1016/j.whi.2024.03.004
23. Kawamata M, Ito F, Tahara N, et al. Characteristics of transferrin saturation and anemia-related biomarkers in patients with uterine adenomyosis. Plos One. 2026;21(3):e0344781. doi:10.1371/journal.pone. 0344781
24. Sabarudin H. Correlation of tumor marker cancer antigen (CA-125) against hemoglobin, leucocytes, and platelet lymphocyte ratio in ovarian cancer patients at RSUD ULIN Banjarmasin. JIlmKedokt Wijaya Kusuma. 2018;7(1):93. doi:10.30742/jikw.v7i1.328
Aims: The present study aims to evaluate the impact of dienogest therapy on CA125 levels, hormonal profile, and systemic
inflammatory indices in patients with endometriosis, a chronic inflammatory disorder in which inflammation constitutes a
fundamental component of the pathophysiology.
Methods
This retrospective, pre–post analytical study included 150 female with endometriosis who received dienogest. Demographic and laboratory data were obtained from electronic medical records. Systemic inflammatory indices including neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), neutrophil-to-monocyte ratio (NMR), plateletto-lymphocyte ratio (PLR), mean platelet volume (MPV), MPV-to-lymphocyte ratio (MPVLR), cancer antigen 125 (CA-125), Systemic Immune-inflammation Index (SII), Systemic Inflammation Response Index (SIRI), and pan-immune-inflammation value (PIV) were evaluated before and after treatment. Statistical analyses were performed using appropriate parametric and nonparametric tests, and correlation analyses were conducted.
Results
Following dienogest therapy, statistically significant reductions were observed in CA125 levels (p=0.010) and PLR (p=0.028), along with decreases in leukocyte, and PCT levels. FSH levels showed a significant increase (p=0.001), whereas LH, estradiol, progesterone, TSH, FT3, and FT4 levels remained unchanged (p>0.05 for all). Significant increases were also noted in hemoglobin, hematocrit, MCV, and MCH values after treatment (p<0.05). No statistically significant differences were detected in NLR, MLR, NMR, MPVLR, SII, SIRI, or PIV. Correlation analyses demonstrated a positive association between CA 125 and PLR, as well as inverse correlations between CA125 and hematocrit.
Conclusion
Dienogest therapy was associated with a reduction in CA125 levels and specific inflammatory markers, alongside improvements in certain hematological parameters in patients with endometriosis. These findings suggest a potential antiinflammatory benefit, indicating that dienogest may be involved in the modulation of systemic inflammatory burden. Furthermore, the preservation of endocrine homeostasis may support its favorable safety profile as an effective therapeutic option in the management of endometriosis.
Methods
This retrospective, pre–post analytical study included 150 female with endometriosis who received dienogest. Demographic and laboratory data were obtained from electronic medical records. Systemic inflammatory indices including neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), neutrophil-to-monocyte ratio (NMR), plateletto-lymphocyte ratio (PLR), mean platelet volume (MPV), MPV-to-lymphocyte ratio (MPVLR), cancer antigen 125 (CA-125), Systemic Immune-inflammation Index (SII), Systemic Inflammation Response Index (SIRI), and pan-immune-inflammation value (PIV) were evaluated before and after treatment. Statistical analyses were performed using appropriate parametric and nonparametric tests, and correlation analyses were conducted.
Results
Following dienogest therapy, statistically significant reductions were observed in CA125 levels (p=0.010) and PLR (p=0.028), along with decreases in leukocyte, and PCT levels. FSH levels showed a significant increase (p=0.001), whereas LH, estradiol, progesterone, TSH, FT3, and FT4 levels remained unchanged (p>0.05 for all). Significant increases were also noted in hemoglobin, hematocrit, MCV, and MCH values after treatment (p<0.05). No statistically significant differences were detected in NLR, MLR, NMR, MPVLR, SII, SIRI, or PIV. Correlation analyses demonstrated a positive association between CA 125 and PLR, as well as inverse correlations between CA125 and hematocrit.
Conclusion
Dienogest therapy was associated with a reduction in CA125 levels and specific inflammatory markers, alongside improvements in certain hematological parameters in patients with endometriosis. These findings suggest a potential antiinflammatory benefit, indicating that dienogest may be involved in the modulation of systemic inflammatory burden. Furthermore, the preservation of endocrine homeostasis may support its favorable safety profile as an effective therapeutic option in the management of endometriosis.
Keywords
Endometriosis, dienogest, CA125, dystemic inflammation, hematological parameters
1. Dai Y, Ye Z, Lin X, Zhang S. Immunopathological insights into endometriosis: from research advances to future treatments. Semin Immunopathol. 2025;47(1):31. doi:10.1007/s00281-025-01058-5
2. Giudice LC, Kao LC. Endometriosis. Lancet. 2004;364(9447):1789-1799. doi:10.1016/S0140-6736(04)17403-5
3. Parasar P, Ozcan P, Terry KL. Endometriosis: epidemiology, diagnosis and clinical management. Curr Obstet Gynecol Rep. 2017;6(1):34-41. doi: 10.1007/s13669-017-0187-1
4. Farland LV, Shah DK, Kvaskoff M, Zondervan KT, Missmer SA. Epidemiological and clinical risk factors for endometriosis. In: D’Hooghe T, ed. Biomarkers for Endometriosis. Springer International Publishing; 2017:95-121. doi:10.1007/978-3-319-59856-7_6
5. McKinnon BD, Kocbek V, Nirgianakis K, Bersinger NA, Mueller MD. Kinase signalling pathways in endometriosis: potential targets for non-hormonal therapeutics. Hum Reprod Update. 2016;22(3):382-403. doi: 10.1093/humupd/dmv060
6. Yarmolinskaya MI, Andreeva EN, Bezhenar VF, Popov AA, Cherkashina SA. Efficacy and safety endpoints of dienogest treatment of endometriosis: a systematic review. J Obstet Women’s Dis. 2025;74(4):86-103. doi:10.17816/JOWD689557
7. Kim HJ, Kim SH, Oh YS, Lee SR, Chae HD. Dienogest may reduce estradiol-and inflammatory cytokine-induced cell viability and proliferation and inhibit the pathogenesis of endometriosis: a cell culture-and mouse model-based study. Biomedicines. 2022;10(11):2992.
8. Ichioka M, Mita S, Shimizu Y, et al. Dienogest, a synthetic progestin, down-regulates expression of CYP19A1 and inflammatory and neuroangiogenesis factors through progesterone receptor isoforms A and B in endometriotic cells. J Steroid Biochemistry Mol Biol. 2015;147: 103-110. doi:10.1016/j.jsbmb.2014.12.008
9. Arıkan FB, Öztürk H. Inflammatory indices in hypertensive hemodialysis patients: clinical implications of MPV and MPVLR. J Med Palliat Care. 2025;6(5):569-574. doi:10.47582/jompac.1773774
10. Arıkan FB, Sağsöz N. Enhancing diagnostic accuracy in polycystic ovary syndrome using novel inflammatory indices. J Kırıkkale Univ Faculty Med. 2025;27(2):217-224.
11. Kurt DS, Akay A, Ulusoy CO, Kurt A, Karabay G, Keskin HL. Evaluation of serum-based inflammatory and haematological markers in patients with endometriosis: a case-control study. Eur J Obstet Gynecol Reproductive Biol. 2025;315:114751. doi:10.1016/j.ejogrb.2025.114751
12. Duan YN, Peng YQ, Xu X, Shi XL, Peng CX. Positive correlation between NLR and PLR in 10,458 patients with endometriosis in reproductive age in China. Eur Rev Med Pharmacological Sci. 2023;27(5):2002-2010. doi: 10.26355/eurrev_202303_31566
13. Seckin B, Ates MC, Kirbas A, Yesilyurt H. Usefulness of hematological parameters for differential diagnosis of endometriomas in adolescents/young adults and older women. Int J Adolescent Med Health. 2021;33(2): 20180078. doi:10.1515/ijamh-2018-0078
14. Chung YS, Shim JE, Baek JK, et al. Gene expression profiling and pathway analysis of the effect of dienogest on ovarian endometriosis: a comparative study. Yonsei Med J. 2025;66(11):780. doi:10.3349/ymj. 2024.0518
15. Momenimovahed Z, Mazidimoradi A, Allahqoli L, Salehiniya H. The role of CA-125 in the management of ovarian cancer: a systematic review. Cancer Reports. 2025;8(3):e70142. doi:10.1002/cnr2.70142
16. Atlihan U, Yavuz O, Ata C, Avsar HA, Erkilinc S. Effects of dienogest treatment on endometrioma-related clinical symptoms and endometrioma size: retrospective cohort study. Front Med. 2025;12: 1581661. doi:10.3389/fmed.2025.1581661
17. Lu BJ, Chen CH. Dienogest as a feasible alternative for luteinizing hormone suppression in progestin-primed ovarian stimulation. Fert Sterility. 2023;120(4):e71. doi:10.1016/j.fertnstert.2023.08.220
18. McCormack PL. Dienogest: a review of its use in the treatment of endometriosis. Drugs. 2010;70(16):2073-2088. doi:10.2165/11206320-000000000-00000
19. Simpson PD, McLaren JS, Rymer J, Morris EP. Minimising menopausal side effects whilst treating endometriosis and fibroids. Post Reprod Health. 2015;21(1):16-23. doi:10.1177/2053369114568440
20. Murta I, Bicca J, Cardoso N. MON-196 hormone replacement therapy in menopausal patient with symptomatic endometriosis and bone metabolism: a case report. J Endocrine Soc. 2025;9(Supplement_1):bvaf 149.1927. doi:10.1210/jendso/bvaf149.1927
21. Guo K, Lu J, Yu H, et al. Serum betatrophin concentrations are significantly increased in overweight but not in obese or type 2 diabetic individuals. Obesity. 2015;23(4):793-797. doi:10.1002/oby.21038
22. Gete DG, Doust J, Mortlock S, Montgomery G, Mishra GD. Risk of iron deficiency in women with endometriosis: a population-based prospective cohort study. Women’s Health Issues. 2024;34(3):317-324. doi:10.1016/j.whi.2024.03.004
23. Kawamata M, Ito F, Tahara N, et al. Characteristics of transferrin saturation and anemia-related biomarkers in patients with uterine adenomyosis. Plos One. 2026;21(3):e0344781. doi:10.1371/journal.pone. 0344781
24. Sabarudin H. Correlation of tumor marker cancer antigen (CA-125) against hemoglobin, leucocytes, and platelet lymphocyte ratio in ovarian cancer patients at RSUD ULIN Banjarmasin. JIlmKedokt Wijaya Kusuma. 2018;7(1):93. doi:10.30742/jikw.v7i1.328
Article Information
Received : 16 Mar 2026
Accepted : 18 Nis 2026
Published : 30 Nis 2026
Accepted : 18 Nis 2026
Published : 30 Nis 2026
Corresponding Author :
[email protected]
Funda Bulut Arıkan: Department of Physiology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkiye
Citation : Bulut Arıkan F, Sağsöz N. Impact of dienogest therapy on CA125 levels, hormonal profile, and systemic inflammatory indices in endometriosis. J Controv Obstetr Gynecol Ped. 2026;4(2):25-30. doi:10.51271/JCOGP-0069
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