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Meta-Analysis
. 2023 Nov;30(11):3135-3143.
doi: 10.1007/s43032-023-01266-0. Epub 2023 May 22.

The Efficacy of Dienogest in Reducing Disease and Pain Recurrence After Endometriosis Surgery: a Systematic Review and Meta-Analysis

Ludovico Muzii  1 , Chiara Di Tucci  2 , Giulia Galati  2 , Fabiana Carbone  2 , Innocenza Palaia  2 , Giorgio Bogani  2 , Giorgia Perniola  2 , Federica Tomao  2 , Evangelos Kontopantelis  3 , Violante Di Donato  2
Affiliations
Meta-Analysis

The Efficacy of Dienogest in Reducing Disease and Pain Recurrence After Endometriosis Surgery: a Systematic Review and Meta-Analysis

Ludovico Muzii et al. Reprod Sci. 2023 Nov.

Abstract

The objective of this study is to determine whether dienogest therapy after endometriosis surgery reduces the risk of recurrence compared with placebo or alternative treatments (GnRH agonist, other progestins, and estro-progestins). The design used in this study is systematic review with meta-analysis. The data source includes PubMed and EMBASE searched up to March 2022. A systematic review and meta-analysis were performed in accordance with guidelines from the Cochrane Collaboration. Keywords such as "dienogest," "endometriosis surgery," "endometriosis treatment," and "endometriosis medical therapy" were used to identify relevant studies. The primary outcome was recurrence of endometriosis after surgery. The secondary outcome was pain recurrence. An additional analysis focused on comparing side effects between groups. Nine studies were eligible, including a total of 1668 patients. At primary analysis, dienogest significantly reduced the rate of cyst recurrence compared with placebo (p < 0.0001). In 191 patients, the rate of cyst recurrence comparing dienogest vs GnRHa was evaluated, but no statistically significant difference was reported. In the secondary analysis, a trend toward reduction of pain at 6 months was reported in patients treated with dienogest over placebo, with each study reporting a significantly higher reduction of pain after dienogest treatment. In terms of side effects, dienogest treatment compared with GnRHa significantly increased the rate of spotting (p = 0.0007) and weight gain (p = 0.03), but it was associated with a lower rate of hot flashes (p = 0.0006) and a trend to lower incidence of vaginal dryness. Dienogest is superior to placebo and similar to GnRHa in decreasing rate of recurrence after endometriosis surgery. A significantly higher reduction of pain after dienogest compared with placebo was reported in two separate studies, whereas a trend toward reduction of pain at 6 months was evident at meta-analysis. Dienogest treatment compared with GnRHa was associated with a lower rate of hot flashes and a trend to lower incidence of vaginal dryness.

Keywords: Dienogest; Endometrioma; Endometriosis; Postoperative medical treatment; Recurrence.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow chart for study identification and inclusion/exclusion
Fig. 2
Fig. 2
Forest plot: endometriosis recurrence with post-operative dienogest compared to placebo/no therapy
Fig. 3
Fig. 3
Forest plot: endometriosis recurrence with post-operative dienogest compared to GnRHa
Fig. 4
Fig. 4
Forest plot: changes in pelvic pain at 6 months comparing dienogest vs placebo/no therapy
Fig. 5
Fig. 5
a Forest plot: rate of spotting comparing dienogest vs GnRHa. b Forest plot: rate of headache comparing dienogest vs GnRHa. c Forest plot: rate of vaginal dryness comparing dienogest vs GnRHa. d Forest plot: rate of weight gain comparing dienogest vs GnRHa. e Forest plot: rate of hot flashes comparing dienogest vs GnRHa
See this image and copyright information in PMC

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