Efficacy of progestogen therapy for extragenital endometriosis: clinical outcomes and MRI-detected changes in lesion characteristics
Alieva P.M., Dumanovskaya M.R., Solopova A.E., Smetnik A.A., Pavlovich S.V.
Objective. To evaluate the efficacy of dienogest and dydrogesterone in patients with extragenital endometriosis (EGE) by assessing the clinical course, quality of life, and dynamics of lesion size and MRI signal characteristics.
Materials and methods. This study included 89 patients with MRI-confirmed EGE, specifically ovarian endometriomas (OE) and/or rectocervical lesions (RCL). Group 1 (n=45) received dydrogesterone (20–30 mg/day) in a prolonged cyclic regimen, while group 2 (n=44) received dienogest (2 mg/day) continuously. The follow-up period was six months. Pelvic MRI was performed using standard protocols, including quantitative assessments of lesion volume, T2-weighted signal intensity, and apparent diffusion coefficient (ADC). Pain intensity, quality of life (SF-20), and psychoemotional status (HADS) were assessed at baseline and 6 months after therapy.
Results. Both drugs provided significant pain relief on the VAS (p<0.001) and improved social functioning as measured by the SF-20. MRI data showed regression of ovarian endometrioma volume by 38.2% (p<0.001) and rectocervical lesions by 34.7% (p<0.001) in the dienogest group. Dydrogesterone reduced ovarian endometrioma volume by 27.2% (p=0.016), although the change in rectocervical lesion volume did not reach statistical significance (p=0.08). Both progestogens were associated with decreased T2-weighted signal intensity and improved lesion homogeneity, reflecting reduced inflammatory and hemorrhagic activities. In the dydrogesterone group, a significant decrease in HADS-A scores was observed (p<0.001), with stable HADS-D scores. Conversely, in the dienogest group, the HADS-D scores increased from 5.9±4.0 to 9.1±3.8 (p<0.001).
Conclusion. Pelvic MRI is a valuable tool not only for primary diagnosis but also for monitoring the effectiveness of hormonal therapy in patients with endometriosis. Both drugs provided a statistically significant reduction in pain. The observed divergent effects on lesion volume on MRI and psychoemotional status should be considered when personalizing treatment selection.
Authors' contributions. Alieva P.M., Dumanovskaya M.R., Solopova A.E. – conception and design of the study, data collection and processing, drafting and editing of the manuscript; Smetnik A.A., Pavlovich S.V. – editing of the manuscript, final approval for submission.
Conflicts of interest. The authors have no conflicts of interest to declare.
Funding. There was no funding for this study.
Ethical Approval. The study was reviewed and approved by the Research Ethics Committee of the V.I. Kulakov NMRC for OG&P (protocol No. 10 of October 20, 2022).
Generative Artificial Intelligence. No artificial intelligence tools were used in the preparation of this manuscript.
Patient Consent for Publication. All patients provided informed consent for the publication of their data.
Authors' Data Sharing Statement. The data supporting the findings of this study are available upon request from the corresponding author after approval from the principal investigator.
For citation: Alieva P.M., Dumanovskaya M.R., Solopova A.E., Smetnik A.A., Pavlovich S.V. Efficacy of progestogen therapy for extragenital endometriosis: clinical outcomes and MRI-detected changes in lesion characteristics.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2026; (8): 143-153 (in Russian)
https://dx.doi.org/10.18565/aig.2026.204
Keywords
endometriosis
conservative treatment
progestins
magnetic resonance imaging
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Received 29.06.2026
Accepted 13.07.2026
About the Authors
Patimat M. Alieva, obstetrician-gynecologist, PhD student at the Department of Gynecological Endocrinology, V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, aalievapm@gmail.com, https://orcid.org/0009-0007-1391-3211Madina R. Dumanovskaya, PhD, Senior Researcher at the Department of Gynecological Endocrinology, V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia,
117997, Russia, Moscow, Ac. Oparin str., 4, m_dumanovskaya@oparina4.ru, https://orcid.org/0000-0001-7286-6047
Alina E. Solopova, Dr. Med. Sci., Leading Researcher at the Department of Radiation Diagnostics, Department of Visual Diagnostics, V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4; Professor, Department of Obstetrics, Gynecology, Perinatology and Perinatal Medicine, I.M. Sechenov First MSMU, Ministry of Health of Russia (Sechenov University), 119991, Russia, Moscow, Trubetskaya, 8-2, a_solopova@oparina4.ru, https://orcid.org/0000-0003-4768-115X
Antonina A. Smetnik, PhD, Head of the Department of Gynecological Endocrinology, V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia, 117997, Russia, Moscow,
Ac. Oparin str., 4, a_smetnik@oparina4.ru, https://orcid.org/0000-0002-0627-3902
Stanislav V. Pavlovich, PhD, Scientific Secretary, V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4; Professor, Department of Obstetrics, Gynecology, Perinatology and Reproductology, I.M. Sechenov First MSMU, Ministry of Health of Russia (Sechenov University),
119991, Russia, Moscow, Trubetskaya str., 8-2, s_pavlovich@oparina4.ru, https://orcid.org/0000-0002-1313-7079
Corresponding author: Patimat M. Alieva, aalievapm@gmail.com
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