POSTOPERATIVE PROGESTIN THERAPY FOR PAIN RELIEF IN PATIENTS WITH DEEP ENDOMETRIOSIS
DOI:
https://doi.org/10.52340/jecm.2023.05.28Ключевые слова:
Deep endometriosis, dysmenorrhea, dienogestАннотация
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.
Скачивания
Библиографические ссылки
Marinho MCP, Magalhaes TF, Fernandes LFC, et al. Quality of Life in Women with Endometriosis: An Integrative Review. J Womens Health (Larchmt). 2018 Mar;27(3):399-408.
Bulletti C, Coccia ME et al. Endometriosis and infertility. J Assist Reprod Gen. 2010 Aug;27(8):441-7.
D'Alterio, M. N., D'Ancona, G., Raslan, M., et al. Management Challenges of Deep Infiltrating Endometriosis. International journal of fertility & sterility, 2021;15(2), 88–94.
Koninckx PR, Ussia A, Adamyan L, Wattiez A, Donnez J. Deep endometriosis: definition, diagnosis, and treatment. Fertil Steril. 2012 Sep;98(3):564-71.
Wild, M., Miskry, T., Al-Kufaishi, A. et al. Medical management of deeply infiltrating endometriosis - 7 year experience in a tertiary endometriosis centre in London. Gynecol Surg 16, 12 (2019).
Becker CM, Gattrell WT, Gude K, Singh SS. Reevaluating response and failure of medical treatment of endometriosis: a systematic review. Fertility and sterility 2017;108:125-136.
Working group of ESGE, ESHRE, and WES, Joerg Keckstein, Christian M Becker, et al., Recommendations for the surgical treatment of endometriosis. Part 2: deep endometriosis, Human Reproduction Open, Volume 2020, Issue 1, 2020,
Laganà AS, La Rosa VL. Multidisciplinary management of endometriosis: current strategies and future challenges. Minerva Med. 2020;111(1):1820.
WT, Gude K, Singh SS. Reevaluating response and failure of medical treatment of endometriosis: a systematic review. Fertil Steril 2017;108:125-136.
Barra, F., Scala, C., Ferrero, S. Current understanding on pharmacokinetics, clinical efficacy and safety of progestins for treating pain associated to endometriosis. Expert Opin. Drug Metab. Toxicol. 2018; 14: 399–415.
Maiorana A, Incandela D, et al. Efficacy of dienogest in improving pain in women with endometriosis: a 12-month single-center experience. Arch Gynecol Obstet. 2017 Sep;296(3):429-433.
Safety and Effectiveness of Dienogest (Visanne®) for Treatment of Endometriosis: A Large Prospective Cohort Study: effective in the treatment of endometriosis Cho B, Roh JW, Park J, Jeong K, Kim TH, Kim YS, Kwon YS, Cho CH, Park SH, Kim SH. Safety and Effectiveness of Dienogest (Visanne®) for Treatment of Endometriosis: A Large Prospective Cohort Study. Reprod Sci. 2020 Mar;27(3):905-915.
Murji A, Biberoğlu K, Leng J, et al. Use of dienogest in endometriosis: a narrative literature review and expert commentary. Curr Med Res Opin. 2020 May;36(5):895-907.
Bizzarri, N., Remorgida, V., Leone Roberti Maggiore, U., et al. Dienogest in the treatment of endometriosis. Expert Opin. Pharmacother. 2014; 15: 1889–1902
Ferrero, S., Remorgida, V., Venturini, P.L., Bizzarri, N. Endometriosis: The effects of dienogest. BMJ clinical evidence. 2015; 2015:0802.
Morotti, M., Sozzi, F., et al. Dienogest in women with persistent endometriosis-related pelvic pain during norethisterone acetate treatment. Eur. J. Obstet. Gynecol. Reprod. Biol. 2014; 183: 188–192
Vannuccini S, Clemenza S, Rossi M, Petraglia F. Hormonal treatments for endometriosis: The endocrine background. Rev Endocr Metab Disord. 2022 Jun;23(3):333-355.
Tanmahasamut P, Saejong R, et al. Postoperative desogestrel for pelvic endometriosis-related pain: a randomized controlled trial. Gynecol Endocrinol. 2017 Jul;33(7):534-539.
Römer T. Long-term treatment of endometriosis with dienogest: retrospective analysis of efficacy and safety in clinical practice. Arch Gynecol Obstet. 2018 Oct;298(4):747-753. doi: 10.1007/s00404-018-4864-8. Epub 2018 Aug 3. Erratum in: Arch Gynecol Obstet. 2019 Jan;299(1):293. PMID: 30076546.
Lai, Z.Z., Yang, H.L., Ha, S.Y., Chang, K.K., et al. Cyclooxygenase-2 in Endometriosis. International Journal of Biological Sciences, 2019;15(13), 2783-2797.
Working group of ESGE, ESHRE, and WES, Joerg Keckstein, Christian M Becker, et al. Recommendations for the surgical treatment of endometriosis. Part 2: deep endometriosis, Human Reproduction Open, Volume 2020, Issue 1, 2020
Bourdel N., Alves J., Pickering G., Ramilo I., Roman H., Canis M. Systematic review of endometriosis pain assessment: How to choose a scale? Hum. Reprod. Update. 2015;21:136–152.
Tanmahasamut P, Saejong R, et al. Postoperative desogestrel for pelvic endometriosis-related pain: a randomized controlled trial. Gynecol Endocrinol. 2017 Jul;33(7):534-539.
Römer T. Long-term treatment of endometriosis with dienogest: retrospective analysis of efficacy and safety in clinical practice. Arch Gynecol Obstet. 2018 Oct;298(4):747-753. doi: 10.1007/s00404-018-4864-8. Epub 2018 Aug 3. Erratum in: Arch Gynecol Obstet. 2019 Jan;299(1):293. PMID: 30076546.
Adachi K, Takahashi K, Nakamura K, et al. Postoperative administration of dienogest for suppressing recurrence of disease and relieving pain in subjects with ovarian endometriomas. Gynecol Endocrinol. 2016 Aug;32(8):646-649.
Khashchenko EP, Uvarova EV, Chuprynin VD, et al. Pelvic Pain, Mental Health and Quality of Life in Adolescents with Endometriosis after Surgery and Dienogest Treatment. J Clin Med. 2023 Mar 20;12(6):2400.
Загрузки
Опубликован
Как цитировать
Выпуск
Раздел
