Short-term histopathological effects of dienogest therapy on ovarian endometriomas: in vivo, nonrandomized, controlled trial

Abstract

Ovarian endometriosis is a common gynecological disorder. To date, progestins are recommended as the first-line medical treatment for symptomatic ovarian endometriosis. The aim of this study was to evaluate the main histopathological effects of short-term dienogest therapy in patients with ovarian endometriomas scheduled for surgery. A prospective, nonrandomized controlled trial, including 70 symptomatic women with single ovarian endometriotic cyst (diameter between 30-50 mm) was conducted. Women scheduled for surgery were divided into two groups, depending on the treatment established at enrollment: 36 women received progestin therapy with dienogest (P group) and 34 women received no therapy (C group). At histopathological examination necrosis, inflammation, decidualization, glandular atrophy and angiogenesis were blindly evaluated. At tissue level, decidualization was significantly more frequent in P group compared to C group (p = .001). A nonsignificant tendency (p = .29) towards a slight decreased inflammation in P group was found. No significant differences were observed between the two groups in terms of necrosis, glandular atrophy and angiogenesis. The study suggests that high decidualization rate and the tendency to reduced inflammatory reaction in the short-term administration of dienogest might contribute to its therapeutic efficacy.

The role of mitogen‐activated protein kinase signaling pathway in endometriosis

“…These synthetic components, which mimic progesterone, act to reduce the symptoms of endometriosis by its anti‐estrogenic, pro‐apoptotic, anti‐inflammatory, and anti‐neurogenic effects in the treatment of endometriosis 95 . In addition to reducing inflammation, progestins also have effects such as stimulating pseudo‐pregnancy conditions and increasing apoptosis 96, 97 …”

Ovarian reserve after three‐step laparoscopic surgery for endometriomas utilizing dienogest: A pilot study

“…6 Dienogest exerts anti-proliferative effects on endometriotic lesion via direct effects of progestational decidual changes of endometriotic tissue or indirectly via lowering circulating estradiol levels inhibiting central gonadotrophin secretions that result in altered follicular growth and ovulation. 7,8 Dienogest may also alleviate pelvic inflammation that caused by endometriosis. 9 Therefore, novel progestin may be a beneficial alternative in the three-step surgical management of endometriomas.…”

“…As a fourth‐generation progestin, dienogest possess high affinity to progesterone receptor and no androgenic effect, which make this medication potent long‐term therapeutic means for women with endometriosis 6 . Dienogest exerts anti‐proliferative effects on endometriotic lesion via direct effects of progestational decidual changes of endometriotic tissue or indirectly via lowering circulating estradiol levels inhibiting central gonadotrophin secretions that result in altered follicular growth and ovulation 7,8 . Dienogest may also alleviate pelvic inflammation that caused by endometriosis 9 .…”

Ovarian reserve after three-step laparoscopic surgery for endometriomas utilizing dienogest: a non-randomized prospective pilot study

“…As a fourthgeneration progestin, dienogest possess high affinity to progesterone receptor and no androgenic effect, which make this medication potent long-term therapeutic means for women with endometriosis [6]. Dienogest exerts anti-proliferative effects on endometriotic lesion via direct effects of progestational decidual changes of endometriotic tissue or indirectly via lowering circulating estradiol levels inhibiting central gonadotrophin secretions that result in altered follicular growth and ovulation [7,8]. Dienogest may also alleviate pelvic inflammation that caused by endometriosis [9].…”