Use of dienogest in endometriosis: a narrative literature review and expert commentary

Abstract

Objective: Endometriosis affects up to 10% of women of reproductive age, and the main goal of treatment is to relieve symptoms. Progestins have been the mainstay of endometriosis suppression, of which dienogest has become an important option in many parts of the world. This is an expert literature review, with recommendations on the use of dienogest in the context of various clinical considerations when treating endometriosis. Methods: A search of PubMed was conducted for papers published between 2007 and 2019 on the use of dienogest in endometriosis. Experts reviewed these and included those they considered most relevant in clinical practice, according to their own clinical experience. Results: Evidence regarding the long-term use (>15 months) of dienogest for the management of endometriosis is presented, with experts concluding that the efficacy of dienogest should be assessed primarily on its impact on pain and quality of life. Fertility preservation, the option to avoid or delay surgery, and managing bleeding irregularities that can occur with this treatment are also considered. Counseling women on potential bleeding risks before starting treatment may be helpful, and evidence suggests that few women discontinue treatment for this reason, with the benefits of treatment outweighing any impact of bleeding irregularities. Conclusions: Overall, the evidence demonstrates that dienogest offers an effective and tolerable alternative or adjunct to surgery and provides many advantages over combined hormonal contraceptives for the treatment of endometriosis. It is important that treatment guidelines are followed and care is tailored to the woman's individual needs and desires.

Risk factors for non‐response and discontinuation of Dienogest in endometriosis patients: A cohort study

“…Genital bleeding during DNG treatment is a potential modifiable factor to improve response to DNG. A 5‐ to 7‐day break of therapy, a course of nonsteroidal anti‐inflammatory drugs or a short‐term application of 1 mg estradiol have been described as valid approaches 16‐18 . Another way to interrupt the bleeding episode may be doubling the dose from 2 mg to 4 mg daily for 5‐7 days.…”

“…In any case, given the high possibility of irregular bleeding patterns. especially at the beginning of the DNG therapy, it is recommended that women be counseled to prepare and reassure them of possible bleeding while support at this time is also advised 17 …”

Impacto do tratamento medicamentoso da endometriose nas questões profissionais, sexuais e econômicas das mulheres

“…Os anticoncepcionais são bastante indicados para o tratamento da endometriose 10 , são muito eficazes e poucos efeitos adversos são relatados, não prejudicando a libido. O dienogeste tem o mesmo efeito no tratamento da endometriose que as medicações anticoncepcionais 11 , mas pode haver perda de libido 7 . O DIU hormonal não altera libido.…”

Gross Ascites Secondary to Endometriosis: A Rare Presentation in Pre-Menopausal Women

“…New progestins are now recommended as first-line hormonal therapy in the management of endometriosis over COC [32]. Notably, Dienogest is a new fourth-generation progestin which offers an effective and tolerable alternative to GnRH analogues and definitive surgical intervention in the long-term treatment of endometriosis [33]. Daily administration of Dienogest 2mg following fertility sparing surgery is associated with lower recurrence rates of both ascites and symptoms of endometriosis [15,31,34].…”