Comparison of the effectiveness of Dienogest with medroxyprogesterone acetate in the treatment of pelvic pain and recurrence of endometriosis after laparoscopic surgery

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Dienogest treatment led to significantly lower pelvic pain and smaller recurrent endometriosis lesion size compared to medroxyprogesterone acetate six months after laparoscopic surgery, with similar recurrence rates.

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This single-center clinical trial studied 106 women with endometriosis who underwent laparoscopic surgery and then received either dienogest (2 mg daily for 3 months then cyclic for 3 more) or medroxyprogesterone acetate (10 mg twice daily for 3 months then cyclic for 3 more). At 6 months follow-up, pelvic pain scores were significantly lower with dienogest than with medroxyprogesterone acetate, and there was no statistically significant difference in overall endometriosis recurrence rate between groups. Dienogest was associated with a smaller size of recurrent endometriosis cysts, although the study’s short follow-up limits conclusions about longer-term recurrence. This paper is centrally about endometriosis — it compares dienogest versus medroxyprogesterone acetate for reducing pelvic pain and recurrence of lesions after laparoscopic endometriosis surgery.

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Abstract

PURPOSE: The aim of this study was to compare the effects of Dienogest and medroxyprogesterone acetate (MPA) on the recurrence of endometriosis lesions and clinical symptoms in women undergoing laparoscopic surgery. METHODS: This single center clinical trial was conducted among 106 women with endometriosis undergoing laparoscopic surgery who candidate receiving post-surgery hormone therapy. Participants were allocated to two groups. The first group received Dienogest pills (2 mg) daily for the first three months and then cyclic for three months afterward. The second group received MPA pills twice daily (10 mg) for three months and then cyclic for the next three months. Six months after the intervention, the rate of endometriosis recurrence, the size of endometriosis lesions and pelvic pain were assess and compared between two groups. RESULTS: Finally, data were evaluated based on 48 and 53 women in the Dienogest and MPA groups, respectively. After 6 months follow-up assessments the pelvic pain score was significantly lower in Dienogest group than MPA group (P < 0.001). There was not statistically difference between two groups in terms of recurrence rate of endometriosis (P = 0.4). Although the size of endometriosis cyst recurrence was smaller in Dienogest group compared to MPA group (P = 0.02). CONCLUSIONS: The findings showed that Dienogest treatment has better effect in reducing pelvic pain and the mean size of the recurrent endometriosis lesions after endometriosis laparoscopic surgery when compared to MPA treatment. Although the recurrent rate of endometriosis was similar between these treatments.
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Abstract

Purpose The aim of this study was to compare the effects of Dienogest and medroxyprogesterone acetate (MPA) on the recurrence of endometriosis lesions and clinical symptoms in women undergoing laparoscopic surgery.

Methods

This single center clinical trial was conducted among 106 women with endometriosis undergoing laparoscopic surgery who candidate receiving post-surgery hormone therapy. Participants were allocated to two groups. The first group received Dienogest pills (2 mg) daily for the first three months and then cyclic for three months afterward. The second group received MPA pills twice daily (10 mg) for three months and then cyclic for the next three months. Six months after the intervention, the rate of endometriosis recurrence, the size of endometriosis lesions and pelvic pain were assess and compared between two groups.

Results

Finally, data were evaluated based on 48 and 53 women in the Dienogest and MPA groups, respectively. After 6 months follow-up assessments the pelvic pain score was significantly lower in Dienogest group than MPA group (P < 0.001). There was not statistically difference between two groups in terms of recurrence rate of endometriosis (P = 0.4). Although the size of endometriosis cyst recurrence was smaller in Dienogest group compared to MPA group (P = 0.02).

Conclusions

The findings showed that Dienogest treatment has better effect in reducing pelvic pain and the mean size of the recurrent endometriosis lesions after endometriosis laparoscopic surgery when compared to MPA treatment. Although the recurrent rate of endometriosis was similar between these treatments. Similar content being viewed by others Data availability Data are available upon request, and patient's privacy.

References

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Fertil Steril 107(3):537–548 Ota Y, Andou M, Yanai S, Nakajima S, Fukuda M, Takano M, Kurotsuchi S, Ebisawa K, Hada T, Ota I (2015) Long-term administration of Dienogest reduces recurrence after excision of endometrioma. J Endometr Pelvic Pain Disord 7(2):63–67 Chandra A, Rho AM, Jeong K, Yu T, Jeon JH, Park SY, Lee SR, Moon H-S, Chung HW (2018) Clinical experience of long-term use of Dienogest after surgery for ovarian endometrioma. Obstet Gynecol Sci 61(1):111–117 Liu Y, Gong H, Gou J, Liu X, Li Z (2021) Dienogest as a maintenance treatment for endometriosis following surgery: a systematic review and meta-analysis. Front Med 8:652505 Funding The study was not founded. This study was support by Tehran University of Medical Sciences. Author information Authors and Affiliations Contributions MVD, HR, RH contributed to design. HR, RH conducted the study, LH and HR prepared the manuscript, HR analyzed the data. All authors read and approved the final manuscript. Corresponding author Ethics declarations Conflict of interest The authors declare that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper. Ethical approval The study was approved by the Ethics Committee of Tehran University of Medical sciences and IRCT number is IRCT20170917036227N5. All patients who agreed to participate in the study provided signed informed consent. Consent to participate Informed consent was obtained from all individual participants included in the study. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Vahid-Dastjerdi, M., Hosseini, R., Rodi, H. et al. Comparison of the effectiveness of Dienogest with medroxyprogesterone acetate in the treatment of pelvic pain and recurrence of endometriosis after laparoscopic surgery. Arch Gynecol Obstet 308, 149–155 (2023). https://doi.org/10.1007/s00404-022-06898-2 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00404-022-06898-2

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Condition tags

endometriosischronic_pelvic_pain

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

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