The role of progestogens in the treatment of endometriosis

Abstract

According to global data the prevalence of endometriosis ranges from 2 to 10% among the general female population and up to 50% among women with infertility. Therefore, at least 190 million women and adolescent girls worldwide have been diagnosed with this disease.Endometriosis, according to evidence, can exhaust a woman physically and emotionally, thereby significantly reducing her quality of life. In particular, pain symptoms affect quality of life and a range of activities and life domains, including physical functioning, daily activities and social life, education and work, sex, intimate relationships and intimate partnerships, and mental health and emotional well-being.This pathology is often accompanied by infertility. Endometriosis has social importance in general, for example due to direct and indirect health care costs comparable to other common diseases such as type 2 diabetes, rheumatoid arthritis and Crohn’s disease.The pathogenesis of endometriosis prompts scientists to search for new methods of conservative treatment. One of the modern means that allow to expand the clinical possibilities of impact on endometriosis is a drug from the dienogest group. The commitment of specialists to the use of dienogest is significantly influenced by the understanding of its pharmacokinetics. After oral use, dienogest is quickly and completely absorbed. The maximum concentration in blood serum is reached within 1.5 hours after a single oral intake and is 47 ng/ml.The bioavailability of dienogest is quite high and is approximately 91%. Its pharmacokinetics are dose-dependent in the dose range of 1–8 mg. Dienogest at a dose of 2 mg/day is an effective alternative to surgery for the long-term treatment of endometriosis, which is well tolerated and has a number of important advantages over combined oral contraceptives. In addition, the available data indicate that patients are ready for possible irregular bleeding, which often occurs with the use of 2 mg of dienogest, since the drug reduces the painful manifestations of endometriosis.In clinical practice, important components of treatment management are counseling patients about expected side effects, evaluating the effectiveness and safety of each therapeutic approach, and following existing recommendations regarding the provision of individual care in accordance with the needs and wishes of each woman. Therefore, dienogest belongs to the standard of treatment of endometriosis, it is included in national and world clinical protocols as a drug of the first line of its treatment.