Dienogest versus continuous oral levonorgestrel/EE in patients with endometriosis: what’s the best choice?

Piacenti, Ilaria; Viscardi, Maria Federica; Masciullo, Luisa; Sangiuliano, Chiara; Scaramuzzino, Sara; Piccioni, Maria Grazia; Muzii, Ludovico; Panici, Pierluigi Benedetti; Porpora, Maria Grazia

doi:10.1080/09513590.2021.1892632

Cited by 22 publications

(15 citation statements)

References 33 publications

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“…Many studies have suggested that DNG is effective in the treatment of deeply infiltrated endometriosis. It can prevent recurrence of post-operative DIE, control post-operative related pelvic pain ( 14 , 15 ), reduce endometriotic lesions ( 71 ), reduce difficulties with intercourse and enhance sexual function ( 13 ), treat symptoms caused by rectosigmoid endometriosis ( 72 ), and improve quality of life ( 73 ). However, there are no studies regarding the use of TCM treatment for DIE.…”

Section: Discussionmentioning

confidence: 99%

“…Dienogest (DNG), a 19-nortestosterone derivative, has good bioavailability and a strong progestational effect because of its high selectivity by progesterone receptors ( 11 ). 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 ).…”

Section: Introductionmentioning

confidence: 99%

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

Liu²,

Jia³

et al. 2022

Front. Surg.

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BackgroundEndometriosis is now considered to be a systemic disease rather than a disease that primarily affects the pelvis. Dienogest (DNG) has unique advantages in the treatment of endometriosis, but it also has side effects. Alternatively, Traditional Chinese Medicine (TCM) has been used for over 2000 years in the treatment and prevention of disease and growing numbers of Chinese scholars are experimenting with the combined use of Dienogest and TCM for endometriosis treatment.ObjectivesThis review evaluated the efficacy and safety of TCM in combination with Dienogest in the treatment of endometriosis through meta-analysis.MethodsMEDLINE, Embase, the Cochrane Library, PubMed, Web of Science, China National Knowledge Infrastructure, Journal Integration Platform, and Wanfang were used in literature searches, with a deadline of May 31, 2022. Literature quality was assessed using the Cochrane Collaboration “risk of bias” (ROB2) tool, and the “meta” package of R software v.4.1 was used for meta-analysis. Dichotomous variables and continuous variables were assessed using the relative risk (RR) and 95% confidence intervals (95% CI); standard mean differences (MD) and 95% CI, respectively.ResultsTwelve human randomized controlled trials (RCTs) and one retrospective study, all 13 written in the Chinese language, were included in the meta-analysis (720 experiments and 719 controls). The result indicated that TCM plus Dienogest was superior to Dienogest/TCM alone in increasing the cure rates (RR = 1.3780; 95% CI, 1.1058, 1.7172; P = 0.0043), remarkable effect rate (RR = 1.3389; 95% CI, 1.1829, 1.5154; P < 0.0001), invalid rate (RR = 0.2299; 95% CI, 0.1591, 0.3322; P < 0.0001), and rate of adverse effects (RR = 0.6177; 95% CI, 0.4288, 0.8899; P = 0.0097). The same conclusion was drawn from the subgroup analysis.ConclusionResults suggest that TCM combined with Dienogest is superior to Dienogest or TCM alone and can be used as a complementary treatment for endometriosis. TCMs have potential to improve clinical efficacy and reduce the side effects of Dienogest. This study was financially supported by Annual Science and Technology Steering Plan Project of Zhuzhou. PROSPERO has registered our meta-analysis as CRD42022339518 (https://www.crd.york.ac.uk/prospero/record_email.php).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Liu²,

Jia³

et al. 2022

Front. Surg.

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“…Surgical treatment of early-stage endometrioma is suggested to provide symptom relief and increase quality of life and decrease the potential negative impact of the disease on future fertility, while surgical intervention is recommended for endometriomas of 6 cm or greater due to the associated risks of infection, rupture, and malignancy [1,9]. Recent small cohort studies have however reported encouraging results of reduction in endometrioma size with oral Dienogest, with one study reporting a 40% and 79% reduction after 6 and 12 months of treatment, respectively [12][13][14][15]. Future research involving larger well-designed studies with a longer-term follow-up data in this area can provide the much-needed quality evidence to support the emerging role of Dienogest in the primary treatment of endometrioma.…”

Section: Discussionmentioning

confidence: 99%

An Unusual Case of a Large Extraovarian Endometrioma in an Adolescent

Loh

Borok

Anderson

et al. 2022

Case Reports in Obstetrics and Gynecology

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Endometriosis in adolescents is often underrecognized and is a contributing factor to significant delays in its diagnosis and management. Extraovarian endometrioma is uncommon, especially in the adolescent age range. We report on a rare case of a large extraovarian endometrioma involving the terminal ileum in an adolescent who presented with abdominal pain and a pelvic mass and its subsequent surgical management. It emphasizes the importance of having a broad differential diagnosis and considers endometriosis in any adolescent with pelvic pain and mass, especially in an atypical context. Increased awareness, education, and research on endometriosis in this young population are essential in order to overcome existing challenges in the early diagnosis and optimal management of this chronic gynaecological condition and avoid morbidity associated with advanced disease.

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“…In some cases, the pain completely disappears. The decrease of cyclic pelvic pain may also be seen in women taking oral contraceptives continuously [42]. In contrast, in AM-related dysmenorrhea, even withdrawal bleeding under hormonal therapy such as combined oral contraceptives (COC) in a cyclical mode can cause severe pain associated with vegetative symptoms such as diarrhea, nausea, and even vomiting.…”

Section: Pathogenesis Of Specific Forms Of Painmentioning

confidence: 99%

Pathogenesis of Endometriosis: The Origin of Pain and Subfertility

Gruber

Mechsner

2021

Cells

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Endometriosis (EM) and adenomyosis (AM) are common conditions with pain and infertility as the principal symptoms. The pathophysiology of pain in EM and AM comprises sensory and somatoform pain mechanisms. Over time, these may aggravate and lead to individual complex disease patterns if not diagnosed and treated. Despite the known facts, several years often pass between the onset of symptoms and diagnosis. Chronic pain disorders with changes on a neuronal level frequently arise and are linked to depressive disorders, with the process becoming a vicious cycle. Additionally, women with EM and AM suffer from sub- and infertility. Low fecundity rates are caused by anatomical changes in combination with behavioral changes in the sexual activity of women with chronic pain as well as local proinflammatory factors that not only decrease implantation rates but also promote early abortions.

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Dienogest versus continuous oral levonorgestrel/EE in patients with endometriosis: what’s the best choice?

Cited by 22 publications

References 33 publications

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

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

An Unusual Case of a Large Extraovarian Endometrioma in an Adolescent

Pathogenesis of Endometriosis: The Origin of Pain and Subfertility

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