Long-term Use of Dienogest can Prevent Recurrence of Endometriomas

Dienogest may be used to prevent post-surgical recurrence of endometriomas.

Key Points

Highlights:

• This study from Seoul, Korea, studied the effectiveness of long-term use of dienogest, a fourth-generation progestin, post-surgical recurrence of endometriomas in women with surgically treated ovarian endometriomas.  

Importance:

• Recurrence of endometriomas is an issue commonly faced by women with the disease. Treatment for recurrence can be financial, emotionally, and physically taxing. Thus, there is a need for a procedure that can prevent recurrence.

What’s done here?

• There were 203 participants in this study. These participants had undergone laparoscopic or robotic surgery to treat ovarian endometriomas.
• The patients were prescribed dienogest (2 mg/day), and followed-up by a health care provider trimonthly for potential side effects and adverse events.
• The results of the women who continued dienogest (more than six months) compared with those who discontinued use before the six months were up, and the recurrence was monitored.

Key results:

• Of the 203 participants included in the study, 182 participants were given dienogest for 12.0 ± 7.1 months, 21 participants ended taking dienogest after 2.4 ± 1.0 months.
• Patients that had bilateral endometriomas were much less likely to stop taking dienogest.
• Discontinued use of dienogest was often associated with abnormal uterine bleeding (15.8%), and this did not change if participants were given post-operative gonadotropin-releasing hormone.
• Other notable side effects include gastrointestinal issues, constipation, acne, headaches, hot flushes, weight gain, edema, and depression. 
• Overall, 3 participants (1.5%) were found to have recurrent endometriomas, and some of them decreased in size when dienogest was re-administered.

Limitations of the study:

• There is no control group without dienogest administration and those which stop are few in number to compare.
• The follow-up period to detect recurrent endometriomas is short.
• The effect of hormone preparations other than dienogest is not comparable.

Lay Summary

Chandra et al. recently published a paper titled “Clinical experience of the long-term use of dienogest after surgery for ovarian endometriomas” in Obstetrics and Gynecology Science. The publication explored the benefits and repercussions associated with long-term use of dienogest, a fourth-generation progestin, in women who have surgery, laparoscopic or robotic, for ovarian endometriomas. 

The study had 203 participants. The participants were prescribed dienogest (2 mg/day) after surgery. The patients attended follow up visits so that the healthcare provider could evaluate and address any and all potential side effects and adverse events. The researchers compared the women who stopped using dienogest over a period of 6 months to those who had been taking dienogest for longer than six months. Recurrence was monitored using transvaginal or transrectal ultrasound.

There were 182 participants who on average were given dienogest for 12 months. Long-term use of dienogest was found to be linked with higher serum CA 19-9 levels. 21 participants stopped taking dienogest after an average of 2.4 months. It was noted that individuals who had surgery for bilateral endometriomas had lower dienogest discontinuation rates. Discontinuation of dienogest was often accompanied by abnormal uterine bleeding. Vaginal bleeding occurred in 15.8% of participants and with regards to vaginal bleeding, it did not matter if the participant was given post-operative gonadotropin-releasing hormone. Other observed side effects include depression, weight gain, acne, edema, gastrointestinal issues, constipation, hot flushes, and headaches. There were only 3 cases of recurrent endometriomas, and some of these recurrent endometriomas reduced in size when dienogest was re-administered.

In conclusion, dienogest does appear to be safe for long-term use as a preventative measure for recurrent endometriomas.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/29372157