Dienogest versus continuous oral levonorgestrel/EE in patients with endometriosis: what's the best choice?

Abstract

OBJECTIVE:

Combined oral contraceptives (COC) and progestogens are widely used for the treatment of endometriosis. The objective of the study is to compare the efficacy of dienogest 2 mg vs continuous oral levonorgestrel/EE (levonorgestrel 0.1 mg/ethinyl estradiol 0.02 mg) on ovarian endometriomas, deep infiltrating endometriosis (DIE), chronic pelvic pain (CPP), dyspareunia, analgesic use, quality of life (QoL), compliance and side effects.

METHODS:

Prospective cohort study. Two cohorts of patients with endometriosis, 50 taking dienogest (group A) and 50 taking continuous levonorgestrel/EE (group B), were evaluated at the beginning of therapy (t0), after 3 (t3) and 6 months (t6). Size of endometriomas, DIE, QoL, pain symptoms, and side effects were assessed.

RESULTS:

Dienogest was significantly effective on CPP (p = .002), dyspareunia (p = .021) ovarian endometriomas (p = .015) and DIE lesions reduction (p = .014). Levonorgestrel/EE was significantly effective on dyspareunia (p = .023). Analgesics consumption significantly decreased in both groups (p < .001). Both treatments significantly improved the QoL. Over 6 months a significant improvement was found, more frequently in patients taking dienogest. The only side effect that both groups complained about was vaginal bleeding, present in the first 3 months of treatment (p < .001).

CONCLUSIONS:

Both treatments are effective and safe for patients with endometriosis. Patients compliance and side effects are similar in both groups, however, there was a significantly higher reduction in endometriotic lesions, pain symptoms, and improvement of the QoL in women taking dienogest than in women taking continuous COC.

• Authors: Ilaria Piacenti, Maria Federica Viscardi, Luisa Masciullo, Chiara Sangiuliano, Sara Scaramuzzino, Maria Grazia Piccioni, Ludovico Muzii, Pierluigi Benedetti Panici, Maria Grazia Porpora
• Journal: Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology (Gynecol Endocrinol) Vol. 37 Issue 5 Pg. 471-475 (May 2021) ISSN: 1473-0766 [Electronic] England
• PMID: 33650928 (Publication Type: Clinical Trial, Comparative Study, Journal Article)

Chemical References

• Antineoplastic Agents, Hormonal
• Contraceptive Agents, Hormonal
• Drug Combinations
• ethinyl estradiol, levonorgestrel drug combination
• Ethinyl Estradiol
• dienogest
• Levonorgestrel
• Nandrolone

Topics

• Adult
• Antineoplastic Agents, Hormonal (therapeutic use)
• Contraceptive Agents, Hormonal (therapeutic use)
• Drug Combinations
• Endometriosis (drug therapy)
• Ethinyl Estradiol (therapeutic use)
• Female
• Humans
• Levonorgestrel (therapeutic use)
• Nandrolone (analogs & derivatives, therapeutic use)
• Prospective Studies