POSTOPERATIVE PROGESTIN THERAPY FOR PAIN RELIEF IN PATIENTS  WITH DEEP ENDOMETRIOSIS

DAVID SKHIRTLADZE; JENARO KRISTESASHVILI; RAMAZ CHAREKISHVILI

doi:10.52340/jecm.2023.05.28

POSTOPERATIVE PROGESTIN THERAPY FOR PAIN RELIEF IN PATIENTS WITH DEEP ENDOMETRIOSIS

Authors

DAVID SKHIRTLADZE Iv. Javakhishvili Tbilisi State University, Faculty of Medicine, Department of Obstetrics, Gynecology and Reproductology
JENARO KRISTESASHVILI Iv. Javakhishvili Tbilisi State University, Faculty of Medicine, Department of Obstetrics, Gynecology and Reproductology
RAMAZ CHAREKISHVILI Evex Medical Corporation, Tbilisi, Georgia

DOI:

https://doi.org/10.52340/jecm.2023.05.28

Keywords:

Deep endometriosis, dysmenorrhea, dienogest

Abstract

Background. Deep endometriosis is an advanced phenotype of endometriosis characterized by pelvic pain often leading to decreased quality of life. Though laparoscopic surgery has become a treatment of choice for patients with deep disease suffering from persisting endometriosis-associated pain, postsurgical management remains a subject of discussion. Some studies suggest that the use of selective progestin–dienogest has a positive effect on improving the pain associated with deep endometriosis. However, the current available evidence is inconclusive regarding the effectiveness of combined surgical and therapeutic approaches for the ultimate management of the disease. Therefore, the aim of the study was to determine the effectiveness dienogest as postsurgical add-on therapy for pain relief in patients with deep endometriosis.

Materials and Methods. A prospective, open-label study was conducted involving 46 patients, ages 21-38 years, who underwent surgical intervention for endometriosis-associated pain. They were randomly divided into two groups depending on their desire to participate in the study. 27 patients received dienogest 3 months after surgery, while the remainder 19 patients received no treatment over the same time interval. The main outcome measure was the intensity of dysmenorrhea assessed before and after surgery employing validated numeric rating scale (NRS). The surgical technique entailed sharp and blunt dissection of pelvic peritoneum per recommendations of the working group of ESGE, ESHRE and WES.

Results: There was statistically significant reduction in the mean dysmenorrhea pain score in both groups (p<0.01). However, patients who had been treated with oral dienogest after surgery exhibited greater statistically significant reduction of pain score at 9 months compared to the patients who only underwent surgery.

Conclusion: Postoperative add-on therapy with dienogest seems to be more effective for pain relief in patients with deep endometriosis compared to surgical intervention alone. Our study results support postsurgical use of dienogest for endometriosis-associated pain as an attempt to contribute to improved quality of life.

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