Dienogest as a Maintenance Treatment for Endometriosis Following Surgery: A Systematic Review and Meta-Analysis

Abstract

This study aimed to comprehensively assess the value of Dienogest (DNG) as a maintenance treatment following conservative surgery for endometriosis in terms of the outcomes of disease and pregnancy. We searched for relevant studies and trials up to November 2020 from PubMed, Cochrane Library, Medline, and EMBASE databases as well as the Web of Science. Patients who received DNG maintenance treatment were compared to those who received other treatments (OT), including the levonorgestrel-releasing intrauterine system (LNG-IUS) and gonadotropin-releasing hormone analogs (GnRH-a), or non-treatment (NT). The primary outcomes were disease recurrence and pregnancy rates. Eleven studies were included in this meta-analysis. The pooled analysis indicated that DNG maintenance treatment was associated with a lower rate of disease recurrence. A significant difference was observed in DNG maintenance treatment compared with NT, but not with OT, in the pregnancy rates postoperatively. Moreover, DNG maintenance treatment was related to a significant increase in vaginal bleeding and weight gain. DNG can be recommended as a maintenance treatment for patients with endometriosis to decrease the rates of disease recurrence following conservative surgery. However, DNG maintenance treatment has no advantage in improving pregnancy rates compared to OT.

Treatment of endometriosis with dienogest in combination with traditional Chinese medicine: A systematic review and meta-analysis

“…A growing body of research has demonstrated the unique advantages of DNG in the treatment of endometriosis: Patients treated with DNG after conservative surgery for endometriosis had a significantly lower risk of postoperative disease recurrence than those with expecting treatment ( 12 ); long-term use of DNG for rectosigmoid endometriosis can relieve symptoms ( 13 ); a significant increase in improvement in endometriosis lesions, pain symptoms, and quality of life were found in women taking DNG compared to women on continuous combined oral contraceptives ( 14 ); it is also an effective drug for controlling the pain symptoms associated with deep infiltrating endometriosis (DIE), even without reducing the volume of DIE nodules ( 15 ); it can be used for a long time and is well tolerated ( 16 ). DNG has therefore been recommended as an alternative method of controlling symptoms associated with endometriosis ( 17 ) and as maintenance therapy for patients with endometriosis to reduce the rate of disease recurrence after conservative surgery ( 18 ). However, the most common side effects of using DNG include irregular vaginal bleeding, weight gain, and headaches ( 19 ).…”

Water-Extracted Prunella vulgaris Alleviates Endometriosis by Reducing Aerobic Glycolysis

“…Importantly, our results demonstrate that a first-line drug for endometriosis, dienogest ( Andres Mde et al, 2015 ; Mori et al, 2015 ; Liu et al, 2021 ), is more efficient than the suppressive effect of PV in inhibiting the incidence of endometriosis. However, with regard to side effects, several clinical studies have reported that dienogest causes abnormal vaginal bleeding, weight gain, headaches, depressed mood, and dizziness ( Cosson et al, 2002 ; Uludag et al, 2021 ).…”

“…PV extract was administered orally at doses of 0.820 mg/kg and 4.100 mg/kg body weight or with 1 mg/ml of dienogest five times a week for 3 weeks after intraperitoneal inoculation of donor uterus tissue ( Figure 1A ). Dienogest, the first-line drug for endometriosis ( Andres Mde et al, 2015 ; Liu et al, 2021 ), was used as a control to evaluate the efficiency of PV in endometriosis. The PV group showed a significant reduction in cyst-like ectopic lesion volume compared to the untreated mice group.…”

Perioperative hormone treatment of endometriosis

“…Postoperative medical treatment and pregnancy are protective factors associated with a lower recurrence rate of ovarian endometriosis after laparoscopic ovarian cystectomy [30]. Postoperative hormone suppression has been proposed as a means of reducing the need for reintervention following endometriosis surgery [7 ▪▪ ,28,30].…”

“…Progestogens aim to cause downregulation of oestrogen receptors and inhibit cell proliferation, inflammation, neovascularization and neurogenesis in endometriosis [6]. Dienogest (DNG) is a selective progestin that only binds to progesterone receptors and is characterized by good tolerance, antiandrogen activity with moderate inhibition of the hypothalamic-pituitary-axis and oestrogen levels [7 ▪▪ ]. DNG maintains therapeutic levels of oestrogen in the treatment of endometriosis without causing perimenopausal symptoms, loss of bone mineral density or growth of endometriosis.…”