title: Maintenance therapy with dienogest following gonadotropin-releasing hormone agonist treatment for endometriosis-associated pelvic pain.
abstract: OBJECTIVE
  To examine whether long-term administration of dienogest following gonadotropin-releasing hormone agonist (GnRH-a) therapy would prolong the relief of pelvic pain while reducing the amount of irregular uterine bleeding.
  
  
  METHODS
  This was a prospective, non-randomized clinical trial. Among the patients suffering from chronic pelvic pain associated with recurrent endometriosis, Group G (n=38) received GnRH-a for 4-6 months and then dienogest (1 mg/day) for 12 months. The dose of dienogest was increased to 1.5 or 2 mg/day when a patient had uncontrollable uterine bleeding {n=15 (39%)}. Group D (n=33) received only dienogest (2 mg/day) for 12 months. Pelvic pain was assessed using a visual analog scale (VAS). Uterine bleeding was semi-quantified using a pictorial blood loss assessment chart (PBAC).
  
  
  RESULTS
  In Group G, GnRH-a significantly reduced the VAS score for pelvic pain, and alleviation was maintained during the 12-month therapy with dienogest. There was no significant difference in pain reduction between Group G and Group D. The PBAC score during the first 6 months on dienogest was significantly smaller in Group G than in Group D.
  
  
  CONCLUSIONS
  Treatment with a GnRH-a followed by long-term dienogest therapy maintains the relief of endometriosis-associated pelvic pain achieved with GnRH-a therapy for at least 12 months. This regimen reduces the amount of irregular uterine bleeding that often occurs during the early phase of dienogest therapy.
authors.affiliation: Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan. kitawaki@koto.kpu-m.ac.jp
authors.forename: Jo
authors.initials: J
authors.lastname: Kitawaki
authors.forename: Izumi
authors.initials: I
authors.lastname: Kusuki
authors.forename: Kaoruko
authors.initials: K
authors.lastname: Yamanaka
authors.forename: Izumi
authors.initials: I
authors.lastname: Suganuma
mesh_terms: D000328:Adult; D002064:Buserelin / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D004715:Endometriosis / Q000150:complications*; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006727:Hormone Antagonists / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D009277:Nandrolone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D017699:Pelvic Pain / Q000188:drug therapy* / Q000209:etiology*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014592:Uterine Hemorrhage / Q000517:prevention & control
chemical_list: D006727:Hormone Antagonists; D007987:Gonadotropin-Releasing Hormone; C023635:dienogest; D009277:Nandrolone; D002064:Buserelin