Dienogest for Endometriosis

Dienogest, a progestin, has potential as a therapy for patients with endometriosis.

Key Points

Highlight:

• Dienogest, a progestin by the name of 17-hydroxy-3-oxo-19-nor-17alfa-pregna-4,9-diene-21-nitrile, has potential as a therapy for the management of endometriosis.

Importance:

• Combined oral contraceptives have historically been used to treat endometriosis; however, research has yet to show if one particular treatment is more effective than others.

What's done here?

• This article gathers information from various sources and educates readers about Dienogest and its potential use as a treatment for endometriosis.

Key results:

• Dienogest has the benefits found in 19-norprogestin and progesterone derivative classes, which include the high affinity for favorable receptors, such as progesterone, and low specificity for unfavorable receptors, such as androgen, which gives its anti-androgenic effect.
• The harmful effects of this compound are similar to other progestins and include pregnancy, lactation, cardiovascular disorders, thromboembolic disorders, history of hepatic disease, sex hormone-dependent abnormalities, and unnatural vaginal bleeding.
• Dienogest inhibits aromatase and 17β-hydroxysteroid dehydrogenase type 1 found in the stromal cells of endometriomas. This helps decrease estrogen, which is deemed necessary for endometriosis disease progression. This compound has also been linked to increased apoptosis of endometriotic cells. Dienogest also minimizes the creation of pro-inflammatory cytokines and angiogenic factors induced by estradiol. The reasons above give Dienogest its ability to manage pelvic pain and reduce the size of endometriotic lesions.
• Dienogest has been shown to reduce the vascularization of endometriotic foci and recurrence rate post-surgery.
• Dienogest pharmacokinetics is not affected by corticoid-binding or sex hormone-binding globulin.
• A study showed that the adverse outcomes associated with using Dienogest are just mild to moderate. This compound has negligible side effects.
• When compared to other progestagens, Dienogest is more expensive.
• Future research is needed to compare Dienogest with other therapies.
• The authors suggest that there be a standardized method of treatment using Dienogest. They also offer a surgical approach that will maximize the effects of the treatment.
• Dienogest may also have potential in the treatment of endometrial malignancies.

Limitations of the study:

• More research is necessary for Dienogest to be used as a therapeutic for endometriosis.

Lay Summary

Laganà et al. recently published an article in Expert Opinion on Drug Metabolism & Toxicology titled “Clinical dynamics of Dienogest for the treatment of endometriosis: from bench to bedside.” This article explored the benefits of using Dienogest, a progestin, to manage Endometriosis.

Dienogest is useful therapy because it has the advantages of 19-norprogestin and progesterone derivative classes without many of the side effects associated with these compounds. Furthermore, Dienogest has been shown to decrease estrogen, which is highly useful in combating endometriosis as the disease is thought to be estrogen-dependent.

"Even though Dienogest is more expensive, expert opinion maintains that this therapy is effective in preventing recurrence post-surgery, reducing pain caused by the illness, and minimizing the size of recurrent lesions", authors concluded.

The authors of this paper recommend that further research should be conducted in order to fully understand the benefits and implications of using Dienogest to treat endometriosis.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/28537213