Archives of Gynecology and Obstetrics

, Volume 295, Issue 3, pp 661–667 | Cite as

Endometrial preparation with Dienogest before hysteroscopic surgery: a systematic review

  • Antonio Simone Laganà
  • Salvatore Giovanni Vitale
  • Vincenzo Muscia
  • Paola Rossetti
  • Massimo Buscema
  • Onofrio Triolo
  • Agnese Maria Chiara Rapisarda
  • Loretta Giunta
  • Vittorio Palmara
  • Roberta Granese
  • Helena Ban Frangež
  • Andrea Romano
General Gynecology
First Online:
Received:
Accepted:

Abstract

Purpose

Hysteroscopic surgery is considered the gold standard for the minimal invasive treatment of many endouterine diseases such as endometrial polyps or submucous myomas. Recently, many studies have evaluated the effect of preoperative administration of a number of drugs to reduce endometrial thickness and achieve important intraoperative advantages. The purpose of this systematic review is to summarize the available evidence about the use of Dienogest, an orally administrable progestin, for endometrial preparation before hysteroscopic surgery.

Methods

All studies published on this topic and indexed on PubMed/MEDLINE, Embase or Google scholar databases were retrieved and analysed.

Results

We retrieved five studies about this topic. Considered together, the published data analyses allow us to conclude that Dienogest is effective in reducing the thickness of the endometrium, the severity of bleeding and also of operative time, with a lower number of side effects compared with other pharmacological preparations or no treatment.

Conclusion

Administration of Dienogest may be an effective and safe treatment for endometrial thinning before operative hysteroscopy. However, this conclusion is based on few reports and further studies to prove or disprove it are warranted.

Keywords

Dienogest Hysteroscopy Pretreatment Endometrial thinning 
This is a preview of subscription content, log in to check access.

Notes

Compliance with ethical standards

Funding

The work was not supported by any Grant/fund.

Conflict of interest

The authors have no proprietary, financial, professional or other personal interest of any nature in any product, service or company. The authors alone are responsible for the content and writing of the paper.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.

References

  1. 1.
    Di Spiezio Sardo A, Bettocchi S, Spinelli M et al (2010) Review of new office-based hysteroscopic procedures 2003–2009. J Minim Invasive Gynecol 17:436–448. doi: 10.1016/j.jmig.2010.03.014 CrossRefGoogle Scholar
  2. 2.
    Gizzo S, Saccardi C, Di Gangi S et al (2014) Secondary amenorrhea in severe Asherman’s syndrome: step by step fertility retrieval by Bettocchi’s hysteroscope: some considerations. Minim Invasive Ther Allied Technol 23:115–119. doi: 10.3109/13645706.2013.835736 CrossRefPubMedGoogle Scholar
  3. 3.
    Laganà AS, Ciancimino L, Mancuso A et al (2014) 3D sonohysterography vs hysteroscopy: a cross-sectional study for the evaluation of endouterine diseases. Arch Gynecol Obstet 290:1173–1178. doi: 10.1007/s00404-014-3366-6 CrossRefPubMedGoogle Scholar
  4. 4.
    Sudano MC, Vitale SG, Rapisarda AMC et al (2015) The REP-b (removal of endometrial pathologies-basket) in-office hysteroscopy. Updates Surg. doi: 10.1007/s13304-015-0294-3 PubMedGoogle Scholar
  5. 5.
    Bradley LD (2002) Complications in hysteroscopy: prevention, treatment and legal risk. Curr Opin Obstet Gynecol 14:409–415. doi: 10.1097/00001703-200208000-00008 CrossRefPubMedGoogle Scholar
  6. 6.
    Kayatas S, Meseci E, Tosun OA et al (2014) Experience of hysteroscopy indications and complications in 5, 474 cases. Clin Exp Obstet Gynecol 41:451–454. doi: 10.12891/ceog17502014 PubMedGoogle Scholar
  7. 7.
    Deffieux X, Gauthier T, Menager N et al (2013) Prevention of the complications related to hysteroscopy: guidelines for clinical practice. J Gynecol Obstet Biol Reprod (Paris) 42:1032–1049. doi: 10.1016/j.jgyn.2013.09.008 CrossRefGoogle Scholar
  8. 8.
    Shveiky D, Rojansky N, Revel A et al (2007) Complications of hysteroscopic surgery: “Beyond the learning curve”. J Minim Invasive Gynecol 14:218–222. doi: 10.1016/j.jmig.2006.07.019 CrossRefPubMedGoogle Scholar
  9. 9.
    Giacobbe V, Rossetti D, Vitale SG et al (2016) Otorrhagia and nosebleed as first signs of intravascular absorption syndrome during hysteroscopy: from bench to bedside. Kathmandu Univ Med J 14:87–89Google Scholar
  10. 10.
    Rai VS, Gillmer MDG, Gray W (2000) Is endometrial pre-treatment of value in improving the outcome of transcervical resection of the endometrium? Hum Reprod 15:1989–1992CrossRefPubMedGoogle Scholar
  11. 11.
    Parazzini F, Vercellini P, De Giorgi O et al (1998) Efficacy of preoperative medical treatment in facilitating hysteroscopic endometrial resection, myomectomy and metroplasty: Literature review. Hum Reprod 13:2592–2597. doi: 10.1093/humrep/13.9.2592 CrossRefPubMedGoogle Scholar
  12. 12.
    Florio P, Filippeschi M, Imperatore A et al (2012) The practicability and surgeons’ subjective experiences with vaginal danazol before an operative hysteroscopy. Steroids 77:528–533. doi: 10.1016/j.steroids.2012.01.017 CrossRefPubMedGoogle Scholar
  13. 13.
    Cicinelli E, Pinto V, Tinelli R et al (2007) Rapid endometrial preparation for hysteroscopic surgery with oral desogestrel plus vaginal raloxifene: a prospective, randomized pilot study. Fertil Steril 88:698–701. doi: 10.1016/j.fertnstert.2006.11.151 CrossRefPubMedGoogle Scholar
  14. 14.
    Bifulco G, Di Spiezio Sardo A, De Rosa N et al (2012) The use of an oral contraceptive containing estradiol valerate and dienogest before office operative hysteroscopy: a feasibility study. Gynecol Endocrinol 28:949–955. doi: 10.3109/09513590.2012.683078 CrossRefPubMedGoogle Scholar
  15. 15.
    Tan YH, Lethaby A (2013) Pre-operative endometrial thinning agents before endometrial destruction for heavy menstrual bleeding. Cochrane Database Syst Rev. doi: 10.1002/14651858.CD010241.pub2 Google Scholar
  16. 16.
    Triolo O, De Vivo A, Benedetto V et al (2006) Gestrinone versus danazol as preoperative treatment for hysteroscopic surgery: a prospective, randomized evaluation. Fertil Steril 85:1027–1031. doi: 10.1016/j.fertnstert.2005.09.034 CrossRefPubMedGoogle Scholar
  17. 17.
    Laganà AS, Palmara V, Granese R et al (2014) Desogestrel versus danazol as preoperative treatment for hysteroscopic surgery: a prospective, randomized evaluation. Gynecol Endocrinol 30:794–797. doi: 10.3109/09513590.2014.929658 CrossRefPubMedGoogle Scholar
  18. 18.
    Shin D, Lee S, Lim KS et al (2013) Pharmacokinetic study of single and multiple oral administrations of 2 mg dienogest in healthy Korean women. Contraception 87:750–755. doi: 10.1016/j.contraception.2012.10.033 CrossRefPubMedGoogle Scholar
  19. 19.
    Zeun S, Lu M, Uddin A et al (2009) Pharmacokinetics of an oral contraceptive containing oestradiol valerate and dienogest. Eur J Contracept Reprod Health Care 14:221–232. doi: 10.1080/13625180902850039 CrossRefPubMedGoogle Scholar
  20. 20.
    Strowitzki T, Faustmann T, Gerlinger C et al (2015) Safety and tolerability of dienogest in endometriosis: pooled analysis from the European clinical study program. Int J Womens Health 7:393–401. doi: 10.2147/IJWH.S77202 CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Mori T, Ito F, Matsushima H et al (2015) Dienogest reduces HSD17β1 expression and activity in endometriosis. J Endocrinol 225:69–76. doi: 10.1530/JOE-15-0052 CrossRefPubMedGoogle Scholar
  22. 22.
    Sofo V, Götte M, Laganà AS et al (2015) Correlation between dioxin and endometriosis: an epigenetic route to unravel the pathogenesis of the disease. Arch Gynecol Obstet. doi: 10.1007/s00404-015-3739-5 Google Scholar
  23. 23.
    Miyashita M, Koga K, Takamura M et al (2014) Dienogest reduces proliferation, aromatase expression and angiogenesis, and increases apoptosis in human endometriosis. Gynecol Endocrinol 3590:1–5. doi: 10.3109/09513590.2014.911279 Google Scholar
  24. 24.
    Vetvicka V, Laganà AS, Salmeri FM et al (2016) Regulation of apoptotic pathways during endometriosis: from the molecular basis to the future perspectives. Arch Gynecol Obstet. doi: 10.1007/s00404-016-4195-6 PubMedGoogle Scholar
  25. 25.
    Laganà AS, Triolo O, Salmeri FM et al (2016) Natural Killer T cell subsets in eutopic and ectopic endometrium: a fresh look to a busy corner. Arch Gynecol Obstet 293:941–949. doi: 10.1007/s00404-015-4004-7 CrossRefPubMedGoogle Scholar
  26. 26.
    Angioni S, Cofelice V, Pontis A et al (2014) New trends of progestins treatment of endometriosis. Gynecol Endocrinol 30:769–773. doi: 10.3109/09513590.2014.950646 CrossRefPubMedGoogle Scholar
  27. 27.
    Bizzarri N, Remorgida V, Leone Roberti Maggiore U et al (2014) Dienogest in the treatment of endometriosis. Expert Opin Pharmacother 15:1889–1902. doi: 10.1517/14656566.2014.943734 CrossRefPubMedGoogle Scholar
  28. 28.
    Maniglio P, Ricciardi E, Laganà AS et al (2016) Epigenetic modifications of primordial reproductive tract: a common etiologic pathway for Mayer–Rokitansky–Kuster–Hauser Syndrome and endometriosis? Med Hypotheses 90:4–5. doi: 10.1016/j.mehy.2016.02.015 CrossRefPubMedGoogle Scholar
  29. 29.
    Petraglia F, Hornung D, Seitz C et al (2012) Reduced pelvic pain in women with endometriosis: efficacy of long-term Dienogest treatment. Arch Gynecol Obstet 285:167–173. doi: 10.1007/s00404-011-1941-7 CrossRefPubMedGoogle Scholar
  30. 30.
    Triolo O, Laganà AS, Sturlese E (2013) Chronic pelvic pain in endometriosis: an overview. J Clin Med Res 5:153–163PubMedPubMedCentralGoogle Scholar
  31. 31.
    Laganà AS, Vitale SG, Trovato MA et al (2016) Full-thickness excision versus shaving by laparoscopy for intestinal deep infiltrating endometriosis: rationale and potential treatment options. Biomed Res Int 2016:1–8. doi: 10.1155/2016/3617179 CrossRefGoogle Scholar
  32. 32.
    White K, Potter JE, Hopkins K et al (2012) Contraindications to progestin-only oral contraceptive pills among reproductive-aged women. Contraception 86:199–203. doi: 10.1016/j.contraception.2012.01.008 CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Hall KS, Trussell J, Schwarz EB (2012) Progestin-only contraceptive pill use among women in the United States. Contraception 86:653–658. doi: 10.1016/j.contraception.2012.05.003 CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Sugimoto K, Nagata C, Hayashi H et al (2015) Use of dienogest over 53 weeks for the treatment of endometriosis. J Obstet Gynaecol Res 41:1921–1926. doi: 10.1111/jog.12811 CrossRefPubMedGoogle Scholar
  35. 35.
    de Andres MP, Lopes LA, Baracat EC, Podgaec S (2015) Dienogest in the treatment of endometriosis: systematic review. Arch Gynecol Obstet 292:523–529. doi: 10.1007/s00404-015-3681-6 CrossRefGoogle Scholar
  36. 36.
    Schindler AE (2011) Dienogest in long-term treatment of endometriosis. Int J Womens Health 3:175–184. doi: 10.2147/IJWH.S5633 CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Laganà AS, Giacobbe V, Triolo O et al (2016) Dienogest as preoperative treatment of submucous myomas for hysteroscopic surgery: a prospective, randomized study. Gynecol Endocrinol 32:408–411. doi: 10.3109/09513590.2015.1128409 CrossRefPubMedGoogle Scholar
  38. 38.
    Zorzela L, Loke YK, Ioannidis JP et al (2016) PRISMA harms checklist: improving harms reporting in systematic reviews. BMJ 352:i157. doi: 10.1136/bmj.i157 CrossRefPubMedGoogle Scholar
  39. 39.
    Kodama M, Onoue M, Otsuka H et al (2013) Efficacy of Dienogest in thinning the endometrium before hysteroscopic surgery. J Minim Invasive Gynecol 20:790–795. doi: 10.1016/j.jmig.2013.04.020 CrossRefPubMedGoogle Scholar
  40. 40.
    Cicinelli E, Pinto V, Quattromini P et al (2012) Endometrial preparation with estradiol plus Dienogest (Qlaira) for office hysteroscopic polypectomy: randomized pilot study. J Minim Invasive Gynecol 19:356–359. doi: 10.1016/j.jmig.2011.12.020 CrossRefPubMedGoogle Scholar
  41. 41.
    Tsuchiya T, Katagiri Y, Maemura T et al (2016) Preoperative dienogest to improve the surgical field of view in resectoscopic surgery. Gynecol Minim Invasive Ther 5:16–19. doi: 10.1016/j.gmit.2015.01.011 CrossRefGoogle Scholar
  42. 42.
    Banno K, Kisu I, Yanokura M et al (2012) Progestin therapy for endometrial cancer: the potential of fourth-generation progestin (Review). Int J Oncol 40:1755–1762. doi: 10.3892/ijo.2012.1384 PubMedGoogle Scholar
  43. 43.
    Saito F, Tashiro H, Yamaguchi M et al (2016) Development of a mouse model for testing therapeutic agents: the anticancer effect of dienogest on endometrial neoplasms. Gynecol Endocrinol 32:403–407. doi: 10.3109/09513590.2015.1124411 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Antonio Simone Laganà
    • 1
  • Salvatore Giovanni Vitale
    • 1
  • Vincenzo Muscia
    • 2
  • Paola Rossetti
    • 2
  • Massimo Buscema
    • 2
  • Onofrio Triolo
    • 1
  • Agnese Maria Chiara Rapisarda
    • 3
  • Loretta Giunta
    • 4
  • Vittorio Palmara
    • 1
  • Roberta Granese
    • 1
  • Helena Ban Frangež
    • 5
  • Andrea Romano
    • 6
  1. 1.Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood “G. Barresi”University of MessinaMessinaItaly
  2. 2.Unit of Diabetology and Endocrino-Metabolic DiseasesHospital for Emergency CannizzaroCataniaItaly
  3. 3.Department of General Surgery and Medical Surgical SpecialtiesUniversity of CataniaCataniaItaly
  4. 4.Department of Clinical and Experimental MedicineUniversity of MessinaMessinaItaly
  5. 5.Department of ReproductionUniversity Medical Center LjubljanaLjubljanaSlovenia
  6. 6.Department of Gynecology and Obstetrics, GROW-School for Oncology and Developmental BiologyMaastricht University Medical CentreMaastrichtThe Netherlands

Personalised recommendations