Skip to main content


Log in

Comparison of dienogest versus triptorelin acetate in premenopausal women with adenomyosis: a prospective clinical trial

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript



To compare the efficacy of the oral dienogest versus triptorelin acetate injection for treatment of premenopausal menorrhagia and pelvic pains in women with uterine adenomyosis.


A total of 41 patients with adenomyosis suffering from pelvic pains and menorrhagia were recruited. First group was managed with oral dienogest (2 mg/day, orally) while the second group received triptorelin acetate (3.75 mg/4 weeks, subcutaneous injection) for 16 weeks. Outpatient follow-up was undertaken after 8 weeks but mean values were calculated at baseline and after 16 weeks (end of treatment).


A total of 41 women were allocated to treatment with dienogest (n = 22) or triptorelin acetate (n = 19); 19 (86.4 %) and 18 (94.7 %)  % of the respective groups completed the trial. Significant reductions in pelvic pains after 16 weeks treatment were obtained in both groups demonstrating the equivalence of dienogest relative to triptorelin acetate. Triptorelin acetate was more effective in controlling of menorrhagia and reduction of uterine volume.


Dienogest may be a valuable alternative to depot triptorelin acetate for treatment of premenopausal pelvic pains in women with uterine adenomyosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  1. Wang PH, Su WH, Sheu BC, Liu WM (2009) Adenomyosis and its variance: adenomyoma and female fertility. Taiwan J Obstet Gynecol 48:232–238

    Article  PubMed  Google Scholar 

  2. Kitawaki J (2006) Adenomyosis: the pathophysiology of an oestrogen-dependent disease. Best Pract Res Clin Obstet Gynaecol 20:493–502

    Article  PubMed  Google Scholar 

  3. Wood C (2001) Adenomyosis: difficult to diagnose, and difficult to treat. Diagn Ther Endosc 7:89–95

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Kitamura Y, Allison SJ, Jha RC, Spies JB, Flick PA, Ascher SM (2006) MRI of adenomyosis: changes with uterine artery embolization. AJR Am J Roentgenol 186:855–864

    Article  PubMed  Google Scholar 

  5. Sheng J, Zhang WY, Zhang JP, Lu D (2009) The LNG-IUS study on adenomyosis: a 3-year follow-up study on the efficacy and side effects of the use of levonorgestrel intrauterine system for the treatment of dysmenorrhea associated with adenomyosis. Contraception 79:18993

    Article  Google Scholar 

  6. Nelson JR, Corson SL (1993) Long-term management of adeno-myosis with a gonadotropin-releasing hormone agonist: a case report. Fertil Steril 59:441–443

    CAS  PubMed  Google Scholar 

  7. Ahmed B, Aboubakr E, Alaa M (2012) Aromatase inhibitors or gonadotropin-releasing hormone agonists for the management of uterine adenomyosis: a randomized controlled trial. Acta Obstet Gynecol Scand 91:489–495

    Article  Google Scholar 

  8. Oettel M, Breitbarth H, Elger W et al (1999) The pharmacological profile of dienogest. Eur J Contracept Reprod Health Care 4:2–13

    Article  Google Scholar 

  9. Köhler G, Faustmann TA, Gerlinger C, Seitz C, Mueck AO (2010) A dose-ranging study to determine the efficacy and safety of 1, 2, and 4 mg of dienogest daily for endometriosis. Int J Gynaecol Obstet 108(1):21–25

    Article  PubMed  Google Scholar 

  10. Dueholm M, Lundorf E, Hansen ES, Ledertoug S, Sørensen JS, Olesen F (2001) Magnetic resonance imaging and transvaginal ultrasonography for diagnosis of adenomyosis. Fertil Steril 76:588–594

    Article  CAS  PubMed  Google Scholar 

  11. Nishida M, Takano K, Arai Y, Ozone H, Ichikawa R (2010) Conservative surgical management for diffuse uterine adenomyosis. Fertil Steril 94(2):715–719

  12. Grimbizis GF, Mikos T, Tarlatzis B2 (2014) Uterus-sparing operative treatment for adenomyosis. Fertil Steril 101(2):472–487

  13. Strowitzki T, Marr J, Gerlinger C et al (2010) Dienogest is as effective as leuprolide acetate in treating the painful symptoms of endometriosis: a 24-week, randomized, multicentre, open-label trial. Hum Reprod 25:633–641

    Article  CAS  PubMed  Google Scholar 

  14. Harada M, Osuga Y, Izumi G, Takamura M, Takemura Y, Hirata T, Yoshino O, Koga K, Yano T, Taketani Y (2011) Dienogest, a new conservative strategy for extragenital endometriosis: a pilot study. Gynecol Endocrinol 27(9):717–720

  15. Hirata Tetsuya, Izumi Gentaro, Takamura Masashi, Saito Ako, Nakazawa Akari, Harada Miyuki, Hirota Yasushi, Koga Kaori, Fujii Tomoyuki, Osuga Yutaka (2014) Efficacy of dienogest in the treatment of symptomatic adenomyosis: a pilot study. Gynecol Endocrinol 30(10):726–729

    Article  CAS  PubMed  Google Scholar 

  16. Foster RH, Wilde MI (1998) Dienogest. Drugs 56:825–833

    Article  CAS  PubMed  Google Scholar 

  17. Horie S, Harada T, Mitsunari M, Taniguchi F, Iwabe T, Terakawa N (2005) Progesterone and progestational compounds attenuate tumor necrosis factor alpha-induced interleukin-8productionvi a nuclear factor kappaB inactivation in endometriotic stromalcells. Fertil Steril 83:1530–1535

    Article  CAS  PubMed  Google Scholar 

  18. Yamanaka A, Kimura F, Kishi Y, Takahashi K, Suginami H, Shimizu Y, Murakami T (2014) Progesterone and synthetic progestin, dienogest, induce apoptosis of human primary cultures of adenomyotic stromal cells. Eur J Obstet Gynecol Reprod Biol 179:170–174

    Article  CAS  PubMed  Google Scholar 

  19. Kang JL, Wang XX, Nie ML, Huang XH (2009) Efficacy of gonadotropin-releasing hormone agonist and an extended-interval dosing regimen in the treatment of patients with adenomyosis and endometriosis. Gynecol Obstet Invest 69:73–77

    Article  PubMed  Google Scholar 

  20. Morelli Michele, Rocca Morena Luigia, Venturella Roberta, Mocciaro Rita, Zull Fulvio (2013) Improvement in chronic pelvic pain after gonadotropin releasing hormone analogue (GnRH-a) administration in premenopausal women suffering from adenomyosis or endometriosis: a retrospective study. Gynecol Endocrinol 29(4):305–308

    Article  CAS  PubMed  Google Scholar 

  21. Hudelist G, Oberwinkler KH, Singer CF et al (2009) Combination of transvaginal sonography and clinical examination for preoperative diagnosis of pelvic endometriosis. Hum Reprod 24:1018–1024

    Article  CAS  PubMed  Google Scholar 

  22. Fedele L, Bianchi S, Dorta M, Arcaini L, Zanotti F, Carinelli S (1992) Transvaginal ultrasonography in the diagnosis of diffuse adenomyosis. Fertil Steril 58:94–97

    CAS  PubMed  Google Scholar 

  23. Khan KN, Kitajima M, Hiraki K, Fujishita A, Nakashima M, Ishimaru T, Masuzaki H (2010) Cell proliferation effect of GnRH agonist on pathological lesions of women with endometriosis, adenomyosis and uterine myoma. Hum Reprod 25(11):2878–2890

    Article  CAS  PubMed  Google Scholar 

  24. Grow DR, Filer RB (1991) Treatment of adenomyosis with long-term GnRH analogues: a case report. Obstet Gynecol 78:538–539

    CAS  PubMed  Google Scholar 

  25. Graser T, Muller A, Mellinger U, Muck AO, Lippert TH, Oette LM (2000) Continuous-combined treatment of the menopause with combinations of oestradiol valerate and dienogest—a dose-ranging study. Maturitas 35:253–261

    Article  CAS  PubMed  Google Scholar 

  26. Irahara M, Harada T Momoeda M, Tamaki Y (2007) Hormonal and histological study on irregular genital bleeding in patients with endometriosis during treatment with dienogest, a novel progestational therapeutic agent. Reprod Med Biol 6:223–228

    Article  CAS  Google Scholar 

  27. Nagata C, Yanagida S, Okamoto A et al (2012) Risk factors of treatment discontinuation due to uterine bleeding in adenomyosis patients treated with dienogest. J Obstet Gynaecol Res 38:639–644

    Article  PubMed  Google Scholar 

  28. Napolitano M, Dolce A, Celenza G, Grandone E, Perilli MG, Siragusa S, Carta G, Orecchioni A, Marian G (2014) Iron-dependent erythropoiesis in women with excessive menstrual blood losses and women with normal menses. Ann Hematol 93:557–563

  29. Warner PE, Critchley HO, Lumsden MA et al (2004) Menorrhagia II: is the 80-mL blood loss criterion useful in management of complaint of menorrhagia? Am J Obstet Gynecol 190:1224–1229

    Article  PubMed  Google Scholar 

  30. Parsanezhad M, Azmoon M, Alborzi S, Rajaeefard A, Zarei A, Kazerooni T, Frank V, Schmidt E (2010) A randomized, controlled clinical trial comparing the effects of aromatase inhibitor (letrozole) and gonadotropin-releasing hormone agonist (triptorelin) on uterine leiomyoma volume and hormonal status. Fertil Steril 93:192–198

    Article  CAS  PubMed  Google Scholar 

  31. Bazot M, Cortez A, Darai E, Rouger J, Chopier J, Antoine JM et al (2001) Ultrasonography compared with magnetic resonance imaging for the diagnosis of adenomyosis: correlation with histopathology. Hum Reprod 16:2427–2433

    CAS  PubMed  Google Scholar 

Download references

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Muhammad Fawzy.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fawzy, M., Mesbah, Y. Comparison of dienogest versus triptorelin acetate in premenopausal women with adenomyosis: a prospective clinical trial. Arch Gynecol Obstet 292, 1267–1271 (2015).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: