P-349 Cabergoline reduces endometriosis associated pain with preservation of menstrual cycles

Abstract Study question Does Cabergoline effectively reduce pain in endometriosis while preserving menstrual cycles compared to Dienogest? Summary answer Cabergoline reduces pain, maintains cycle regularity, and exhibits anti-inflammatory effects, unlike Dienogest, making it a promising alternative for endometriosis management, especially in infertility treatment. What is known already Dienogest is an established treatment for endometriosis-associated pain but frequently causes menstrual disturbances, including amenorrhea. It cannot be given in patients seeing fertility. Dopamine agonists like Cabergoline have demonstrated anti-angiogenic and anti-inflammatory effects, suggesting potential benefits in pain relief while preserving menstrual function. Study design, size, duration A prospective, randomized controlled study over six months included 60 women diagnosed with endometriosis via laparoscopy or ultrasound. Participants were randomized into two treatment groups: Cabergoline (0.5 mg twice weekly) and Dienogest (2 mg daily). Participants/materials, setting, methods Sixty women under 40 years old with endometriosis were recruited and randomized into equal groups. Exclusion criteria included BMI >30 kg/m², intent to conceive, chronic inflammatory conditions, or recent infections. The primary outcomes were pain reduction assessed via VAS score and menstrual cycle preservation. Secondary outcomes included changes in serum VEGF, TNF-α, hsCRP, and endometrioma volume. Main results and the role of chance Both treatments significantly reduced pain (VAS score: Cabergoline 6.9±2.2 to 2.9±1.6, p < 0.001; Dienogest 7.4±1.9 to 2.8±1.3, p < 0.001). However, Cabergoline preserved regular menstrual cycles in all cases, whereas 43.33% of Dienogest users experienced amenorrhea and 26.67% had infrequent menstruation. Cabergoline significantly reduced serum VEGF (p = 0.003), hsCRP (p < 0.001), and TNF-α (p = 0.027) levels, whereas Dienogest showed a reduction in TNF-α (p = 0.006) and hsCRP (p = 0.031) but not VEGF (p = 0.629). Both treatments led to a significant decrease in endometrioma size (Cabergoline: p = 0.005; Dienogest: p = 0.001). Limitations, reasons for caution The study duration was limited to nine months, and long-term effects on pain recurrence and fertility outcomes remain uncertain. Larger, long-term studies are needed for further validation. Wider implications of the findings Cabergoline emerges as a promising alternative to Dienogest for endometriosis treatment, particularly for individuals seeking pain relief while preserving menstrual function. Its role in fertility treatment and long-term disease management warrants further exploration. Trial registration number No