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Comparison of effect of preoperative dienogest and gonadotropin-releasing hormone agonist administration on laparoscopic cystectomy for ovarian endometriomas

  • General Gynecology
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Abstract

Purpose

To compare the effects of preoperative dienogest (DNG) and gonadotropin-releasing hormone (GnRH) agonist administration on the improvement of preoperative symptoms and surgical outcomes in patients who underwent laparoscopic cystectomy for ovarian endometriomas.

Methods

Seventy patients who were scheduled for laparoscopic surgery were enrolled in the study. They were divided into two groups: 35 patients who received DNG for 4 months preoperatively (group D) and 35 patients who received low-dose sustained-release goserelin acetate for 4 months preoperatively (group G). Preoperative outcomes, including pain score associated with endometriosis, using the numerical rating scale (NRS), adverse events of hormonal therapy and Kupperman index (KI) before and after treatment, surgical outcomes including total surgical duration and blood loss, and postoperative recurrence of endometrioma were compared between the two groups.

Results

Regarding preoperative symptoms, NRS and KI at 4 months after preoperative hormonal therapy were significantly lower in group D than in group G (NRS, 5.3 ± 5.5 vs. 2.7 ± 3.9; P = 0.01; KI, 16.0 ± 11.0 vs. 9.2 ± 7.6; P = 0.006). Regarding adverse events, the incidence of hot flashes was significantly lower in group D than in group G (P < 0.001). Meanwhile, the incidence of breast pain and metrorrhagia was significantly higher in group D than in group G (P = 0.04 and P < 0.001, respectively). The total surgical duration and blood loss were not significantly different between the groups. At 12 months after surgery, ovarian endometrioma did not recur in either group.

Conclusion

Preoperative administration of DNG is more valuable for patients with endometriosis and scheduled for laparoscopic surgery to improve symptoms with good efficacy and tolerability than the administration of GnRH agonist.

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Acknowledgements

We gratefully acknowledge the work of past members of the Department of Obstetrics and Gynecology at Juntendo University Faculty of Medicine.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan

    Rie Ozaki, Makoto Jinushi, Shinichiro Ikuma, Keisuke Murakami, Yu Kawasaki & Mari Kitade

  2. Department of Obstetrics and Gynecology, Tokyo Women’s Medical University, 8-1, Kawada-cho, Shinjyuku-ku, Tokyo, 162-8666, Japan

    Jun Kumakiri

Authors
  1. Rie Ozaki
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  2. Jun Kumakiri
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  3. Makoto Jinushi
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  4. Shinichiro Ikuma
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  5. Keisuke Murakami
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  6. Yu Kawasaki
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  7. Mari Kitade
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Contributions

RO: data collection or management, data analysis, and manuscript writing. JK: protocol/project development, data collection, data analysis, and manuscript editing. MJ, SI, KM, YK, and MK: data collection and management.

Corresponding author

Correspondence to Jun Kumakiri.

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The authors declare that they have no conflict of interest.

Ethical approval

The study protocol was approved by the Ethics Committee of Juntendo University Faculty of Medicine. The study was conducted after a successful registration at the University Hospital Medical Information Network (UMIN) (ID: 000006469). The study was in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Ozaki, R., Kumakiri, J., Jinushi, M. et al. Comparison of effect of preoperative dienogest and gonadotropin-releasing hormone agonist administration on laparoscopic cystectomy for ovarian endometriomas. Arch Gynecol Obstet 302, 969–976 (2020). https://doi.org/10.1007/s00404-020-05691-3

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  • DOI: https://doi.org/10.1007/s00404-020-05691-3

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