title: Dienogest compared with gonadotropin-releasing hormone agonist after conservative surgery for endometriosis.
abstract: OBJECTIVE
  Although there are various hormone therapies, including gonadotropin-releasing hormone agonist, danazol, levonorgestrel-releasing intrauterine system, dienogest, and low-dose estrogen progestin, no consensus opinion has been reached in terms of which medication should be used and for how long it should be administered. We aimed to determine whether dienogest or goserelin is the better postoperative therapy to prevent recurrence of endometriosis.
  
  
  METHODS
  A prospective cohort randomized study were conducted, including 198 patients diagnosed as having endometriosis. A total of 111 patients were randomly assigned into two groups: the dienogest-administered group (n = 56) and the goserelin-administered group (n = 55). Patients were followed for 24 months after laparoscopic surgery. Those who gave consent but desired no postoperative therapy were assigned to the non-treatment group (n = 79). Recurrence, side-effects, degrees of menstrual pain and chronic pelvic pain measured by the Visual Analogue Scale were compared among the three groups: the dienogest, goserelin, and non-treatment groups.
  
  
  RESULTS
  No significant difference was observed in the postoperative recurrence rate between the dienogest and goserelin groups. No significant difference was found in the recurrence rate between the goserelin group and non-treatment group; however, a significant difference was found in the recurrence rate between the dienogest group and the non-treatment group (P = 0.027). Menstrual pain and chronic pelvic pain were significantly improved in both treatment groups. Side-effects were markedly observed in the goserelin group as compared with the dienogest group.
  
  
  CONCLUSIONS
  Dienogest is available for prolonged administration of more than 6 months, so it is more useful than goserelin, which is available only for short-term administration.
authors.affiliation: Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo, Japan.|St. John's Society Sakuramachi Hospital, Tokyo, Japan.
authors.forename: Yotaro
authors.initials: Y
authors.lastname: Takaesu
authors.affiliation: Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo, Japan. nishih@tokyo-med.ac.jp.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Nishi
authors.affiliation: Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Kojima
authors.affiliation: Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Sasaki
authors.affiliation: Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Nagamitsu
authors.affiliation: Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Rina
authors.initials: R
authors.lastname: Kato
authors.affiliation: Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Isaka
mesh_terms: D000328:Adult; D000072700:Conservative Treatment / Q000379:methods*; D004715:Endometriosis / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D017273:Goserelin / Q000009:adverse effects / Q000627:therapeutic use; D006727:Hormone Antagonists / Q000627:therapeutic use*; D006801:Humans; D009277:Nandrolone / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010146:Pain / Q000150:complications / Q000188:drug therapy; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D012008:Recurrence; D055502:Secondary Prevention / Q000379:methods
chemical_list: D006727:Hormone Antagonists; D017273:Goserelin; D007987:Gonadotropin-Releasing Hormone; C023635:dienogest; D009277:Nandrolone
keywords: Visual Analogue Scale; dienogest; endometriosis; goserelin; recurrence; surgery