early menarche, heavy and prolonged menstrual bleeding, obesity, smoking, stress and unfavorable ecology (2). Nowadays, it is well recognized that treatment of endometriosis should be comprehensive and divided into several stages. In particular, some authors believe that such treatment should include a combination of operative treatment and hormonal suppressive therapy. One of the most perspective drugs in this scope is dienogest, which has been registered in the Russian Federation in 2011. Dienogest is distinct from the other derivatives of 19-nortestosterone: it contains 17-alpha-cyanomethyl group instead of 17-alpha-ethynyl group, and an additional double bond in the Bring. As a result, the size of the molecule, its hydrophobicity and polarity is changed, which affects the absorption, distribution, metabolism and pharmacodynamics of dienogest (1, 5). This drug is a synthetic steroid with a pronounced progestogenic activity (including endometrial), which, at the same time, does not possess any androgenic, estrogenic, antiestrogenic and corticosteroid-like effects (1, 5). Evaluation of dienogest in a number of clinical studies has demonstrated that the standard dose (2 mg/day for 6-9 months) does not affect lipid metabolism; in this regard, it is similar to progesterone. Another important feature of dienogest is a beneficial effect on the central nervous system (6, 7). Patients receiving dienogest notice that their sleep, concentration and ability to memorize improve, it also seems to reduce irritability and depression, which is of major importance in patients with endometriosis. Another potential mechanism of dienogest action, important for endometriosis
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