Lipid Metabolism During Treatment of Endometriosis with the Progestin Dienogest

Abstract

The effects of a new progestational compound, dienogest (17 alpha-cyanomethyl-17 beta-hydroxy-estra-4,9-dien-3-one) on lipid metabolism have been studied in 84 otherwise healthy women with laparoscopically proven endometriosis. The women, aged 17 to 45, years were treated with 2 mg dienogest in tablet form daily for 24 weeks. The progestin was highly effective on endometriotic lesions and symptoms, showing an objective endoscopic and a subjective symptomatic improvement in 80% and 83% respectively. Triglycerides, total cholesterol, HDL-cholesterol, LDL-cholesterol and the LDL-cholesterol/HDL-cholesterol ratio were determined before and after 1, 3 and 6 months use of the progestin. There was a maximum decrease of -5.8% in HDL-cholesterol and of -6.5% in triglycerides after 6 months of therapy vis-à-vis the pretreatment values. The maximum increase in LDL-cholesterol of +5.0% was recorded by the end of the first month of dienogest ingestion. The LDL-cholesterol/HDL-cholesterol ratio rose from 1.6 to 1.8 during the course of therapy. There were no significant changes. The data suggest that 2 mg dienogest has little influence on lipid metabolism and provides also in this respect a suitable approach to the hormonal therapy of endometriosis.

A dose‐ranging study to determine the efficacy and safety of 1, 2, and 4 mg of dienogest daily for endometriosis

“…The absence of notable effects on lipid, carbohydrate, and liver metabolism is consistent with other investigations of dienogest in endometriosis [12,13,21]. A neutral effect on lipids was also observed for dienogest combined with ethinyl estradiol [22].…”

“…Clinical trials of dienogest in endometriosis were initiated in the 1980s by Köhler et al [10], although political factors in Germany then delayed further investigation for several years. The original trial and follow-up investigations, which studied dienogest at a range of doses, report consistent efficacy with a safety profile that includes lack of androgenicity and estrogenic activity and minimal impact on metabolic parameters [11][12][13][14][15].…”

Dienogest is as effective as leuprolide acetate in treating the painful symptoms of endometriosis: a 24-week, randomized, multicentre, open-label trial

“…The safety and tolerability findings from the current trial support the findings of previous studies of dienogest in endometriosis (Kö hler et al, 1989(Kö hler et al, , 2010Schindler et al, 2006;Seitz et al, 2008;Harada et al, 2009).…”

Effects of oral contraceptives on metabolic parameters in adult premenopausal women: a meta-analysis

“…Meanwhile, norgestimate did not affect HDLc and levonorgestrel significantly reduced it. Clinical trials of dienogest did not report on HDLc but a previous observational study of patients with endometriosis did show a tendency to lower it ( 89 ). On the other hand, the effect of OCs on plasma LDLc was generally more modest, and affected to the greater extent by the duration of use.…”