title: Norethindrone acetate or dienogest for the treatment of symptomatic endometriosis: a before and after study.
abstract: OBJECTIVE
  To assess the proportion of patients satisfied with their treatment before and after a systematic change from norethindrone acetate to dienogest as the first-line progestin for symptomatic endometriosis.
  
  
  METHODS
  Before and after study.
  
  
  METHODS
  Academic department.
  
  
  METHODS
  The last 90 new consecutive endometriosis patients in whom norethindrone acetate was used, and the first 90 new consecutive endometriosis patients in whom dienogest was used.
  
  
  METHODS
  Norethindrone acetate at the oral dose of 2.5 mg once a day until June 6, 2013, then dienogest at the oral dose of 2 mg once a day thereafter.
  
  
  METHODS
  Degree of satisfaction with treatment after 6 months of progestin therapy and assessment of any variations in pain symptoms, psychological status, sexual function, or health-related quality of life associated with the introduction of dienogest.
  
  
  RESULTS
  The proportion of satisfied plus very satisfied women after 6 months of treatment was 71% in the "before" period (norethindrone acetate) and 72% in the "after" period (dienogest). The implementation of dienogest was not associated with statistically significant ameliorations in overall pain relief, psychological status, sexual functioning, or health-related quality of life. Treatment was well tolerated by 58% of norethindrone acetate users compared with 80% of dienogest users. After dienogest implementation, the absolute risk reduction in the occurrence of any side effect was 13.9% (95% confidence interval, 0.8%-28.6%).
  
  
  CONCLUSIONS
  Considering the large difference in the cost of the two drugs, dienogest should be suggested selectively in women who do not tolerate norethindrone acetate.
authors.affiliation: Department of Clinical Science and Community Health, Istituto "Luigi Mangiagalli", Università degli Studi, Milan, Italy. Electronic address: paolo.vercellini@unimi.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Vercellini
authors.affiliation: Department of Clinical Science and Community Health, Istituto "Luigi Mangiagalli", Università degli Studi, Milan, Italy.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Bracco
authors.affiliation: IRCCS Mario Negri Institute for Pharmacological Research, Milan, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Mosconi
authors.affiliation: IRCCS Mario Negri Institute for Pharmacological Research, Milan, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Roberto
authors.affiliation: Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Alberico
authors.affiliation: Department of Clinical Science and Community Health, Istituto "Luigi Mangiagalli", Università degli Studi, Milan, Italy.
authors.forename: Dridi
authors.initials: D
authors.lastname: Dhouha
authors.affiliation: Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Edgardo
authors.initials: E
authors.lastname: Somigliana
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D057915:Drug Substitution; D004715:Endometriosis / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006801:Humans; D009277:Nandrolone / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics; D009640:Norethindrone / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics; D000077563:Norethindrone Acetate; D017060:Patient Satisfaction; D011372:Progestins / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D011788:Quality of Life; D016896:Treatment Outcome
chemical_list: D011372:Progestins; C023635:dienogest; D009277:Nandrolone; D000077563:Norethindrone Acetate; D009640:Norethindrone
keywords: Before and after study; dienogest; endometriosis; norethisterone acetate; pelvic pain