First-line hormone treatment for endometriosis

Tikhomirov A.L.

A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow, Russia
The review demonstrates that endometriosis is now considered as a chronic recurrent disease that requires early diagnosis and long-term, often combination treatment. It analyzes the efficacy of drugs used in the treatment of endometriosis and the mechanism of their action. First-line hormone therapy is recognized to be the use of currently available progestogens that can be successfully used in outpatient practice not only for relief of endometriosis-associated painful symptoms, but also for anti-relapse purposes after laparoscopic surgery. Dienogest is a thoroughly studied drug as this approach. The review considers the results of hormone treatment with a progestogen (a dienogest 2 mg tablet) that causes a decidual transformation, as well as anti-inflammatory and anti-angiogenic effects in the endometrioid explants, which can yield the favorable results of dienogest therapy in young patients with deep infiltrating endometriosis who have refused surgical treatment.
Conclusion. It presents the importance of timely diagnosis of endometriosis and the feasibility of a combined approach to its treatment, including medical (nonsteroidal anti-inflammatory drugs, progestins, hormonal contraceptives, aromatase inhibitors, progesterone receptor modulators) and surgical methods.

Keywords

endometriosis
gestagens
dienogest

References

  1. Министерство здравоохранения Российской Федерации. Клинические рекомендации. Эндометриоз. МКБ 10: N80 ID:КР259/1. Российское общество акушеров-гинекологов; 2020. [Endometriosis. Clinical Recommendations of Ministry of Health of Russia, 2020. (in Russian)].
  2. Rogers P.A., Adamson G.D., Al-Jefout M., Becker C.M., D'Hooghe T.M., Dunselman G.A. et al. Research priorities for endometriosis. Reprod. Sci. 2017; 24(2): 202-26. https://dx.doi.org/10.1177/1933719116654991.
  3. Dunselman G.A., Vermeulen N., Becker C., Calhaz-Jorge C., D'Hooghe T., De Bie B. et al. ESHRE guideline: management of women with endometriosis. Hum. Reprod. 2014; 29(3): 400-12. https://dx.doi.org/10.1093/humrep/det457.
  4. Saraswat L., Ayansina D., Cooper K., Bhattacharya S., Horne A., Bhattacharya S. Impact of endometriosis on risk of further gynaecological surgery and cancer: a national cohort study. BJOG. 2018; 125(1): 64-72. https://dx.doi.org/10.1111/1471-0528.14793.
  5. Дубровина С.О., Берлим Ю.Д. Медикаментозное лечение боли, связанной с эндометриозом. Акушерство и гинекология. 2019; 2: 34-40. https://dx.doi.org/10.18565/aig.2019.2.34-40. [Dubrovina S.O., Berlim Yu.D. Medical treatment of pain associated with endometriosis. Obstetrics and gynecology. 2019; 2: 34-40. (in Russian)].
  6. Министерство здравоохранения Российской Федерации. Клинические рекомендации. Эндометриоз. МКБ-10: N80 ID:КР259. Общество по репродуктивной медицине и хирургии; Российская ассоциация гинекологов-эндоскопистов; Российская ассоциация по эндометриозу; Российская ассоциация эндокринологов; Российское общество акушеров-гинекологов; 2016. Эндометриоз. Клинические рекомендации МЗ РФ, 2016. [Endometriosis. Clinical recommendations of Ministry of Health of Russia, 2016. (in Russian)].
  7. Xholli A., FiLip G., Previtera F., Cagnacci A. Modification of endometrioma size during hormone therapy containing dienogest. Gynecol. Endocrinol. 2020; 36(6): 545-9. https://dx.doi.org/10.1080/09513590.2019.1703942.
  8. Patel B.G., Rudnicki M., Yu J., Shu Y., Taylor R.N. Progesterone resistance in endometriosis: origins, consequences and interventions. Acta Obstet. Gynecol. Scand. 2017; 96(6): 623-32. https://dx.doi.org/10.1111/aogs.13156.
  9. Abdou A.M., Ammar I.M.M., Alnemr A.A.A., Abdelrhman A.A. Dienogest Versus Leuprolide Acetate for Recurrent Pelvic Pain Following Laparoscopic Treatment of Endometriosis. J. Obstet. Gynaecol. India. 2018; 68(4): 306-13. https://dx.doi.org/10.1007/s13224-018-1119-3.
  10. Maiorana A., Incandel D., Parazzini F., Alio W., Mercurio A., Giambanco L., Alio L. Efficacy of dienogest in improving pain in women with endometriosis: a 12-month single-center experience. Arch. Gynecol. Obstet. 2017: 296(3): 429-33. https://dx.doi.org/10.1007/s00404-017-4442-5.
  11. Sugimoto K., Nagata C., Hayashi H., Yanagida S., Okamoto A. Use of dienogest over 53 weeks for the treatment of endometriosis. J. Obstet. Gynaecol. Res. 2015; 41(12): 1921-6. https://dx.doi.org/10.1111/jog.12811.
  12. Hirata T., Izumi G., Takamura M., Saito A., Nakazawa A., Harada M. et al. Efficacy of dienogest in the treatment of symptomatic adenomyosis: a pilot study. Gynecol. Endocrinol. 2014; 30(10): 726-9. https://dx.doi.org/10.3109/09513590.2014.926882.
  13. Takaesu Y., Nishi H., Kojima J., Sasaki T., Nagamitsu Y., Kato R., Isaka K. Dienogest compared with gonadotropin-releasing hormone agonist after conservative surgery for endometriosis. J. Obstet. Gynaecol. Res. 2016; 42(9): 1152-8. https://dx.doi.org/10.1111/jog.13023.
  14. Lee S.R., Yi K.W., Song J.Y., Seo S.K., Lee D.Y., Cho S., Kim S.H. Efficacy and safety of long-term use of dienogest in women with ovarian endometrioma. Reprod. Sci. 2017; 25(3): 341-6. https://dx.doi.org/10.1177/1933719117725820.
  15. Agarwa S., Fraser M.A., Chen I., Singh S.S. Dienogest for the treatment of deep endometriosis: Case report and literature review. J. Obstet. Gynaecol. Res. 2014: 41(2): 309-13. https://dx.doi.org/10.1111/jog.12527.
  16. Techatraisak K., Hestiantoro A., Ruey S., Banal-Silao M.J., Kim M.R., Seong S.J. et al. Effectiveness of dienogest in improving quality of life in Asian women with endometriosis (ENVISIOeN): interim results from a prospective cohort study under real-life clinical practice. BMC Womens Health. 2019; 19(1): 68. https://dx.doi.org/10.1186/s12905-019-0758-6.
  17. Strowitzki T., Faustmann T., Gerlinger C., Schumacher U., Ahlers C., Seitz C. Safety and tolerability of dienogest in endometriosis: pooled analysis from the European clinical study program. Int. J. Womens Health. 2015; 7: 393-401. https://dx.doi.org/10.2147/IJWH.S77202.

Received 15.04.2021

Accepted 20.04.2021

About the Authors

Alexander L. Tikhomirov, MD, Professor of the Department of Obstetrics and Gynecology of the Medical Faculty, A.I. Evdokimov Moscow State Medical and Dental University, Ministry of Health of Russia; President of the Interregional Association of Doctors Engaged in the Study and Treatment of Uterine Fibroids.
Tel.: +7(495)609-67-00. E-mail: pacificoff@mail.ru. 20/1, Delegatskaya str., Moscow, 127473, Russia.

For citation: Tikhomirov A.L. First-line hormone treatment for endometriosis.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2021; 5: 153-156 (in Russian)
https://dx.doi.org/10.18565/aig.2021.5.153-156

Similar Articles

By continuing to use our site, you consent to the processing of cookies that ensure the proper functioning of the site.