title: Endometrial preparation with Dienogest before hysteroscopic surgery: a systematic review.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy. antlagana@unime.it.
authors.forename: Antonio Simone
authors.identifier: http://orcid.org/0000-0003-1543-2802
authors.initials: AS
authors.lastname: Laganà
authors.affiliation: Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy.
authors.forename: Salvatore Giovanni
authors.initials: SG
authors.lastname: Vitale
authors.affiliation: Unit of Diabetology and Endocrino-Metabolic Diseases, Hospital for Emergency Cannizzaro, Catania, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Muscia
authors.affiliation: Unit of Diabetology and Endocrino-Metabolic Diseases, Hospital for Emergency Cannizzaro, Catania, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Rossetti
authors.affiliation: Unit of Diabetology and Endocrino-Metabolic Diseases, Hospital for Emergency Cannizzaro, Catania, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Buscema
authors.affiliation: Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy.
authors.forename: Onofrio
authors.initials: O
authors.lastname: Triolo
authors.affiliation: Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy.
authors.forename: Agnese Maria Chiara
authors.initials: AM
authors.lastname: Rapisarda
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
authors.forename: Loretta
authors.initials: L
authors.lastname: Giunta
authors.affiliation: Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Palmara
authors.affiliation: Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Granese
authors.affiliation: Department of Reproduction, University Medical Center Ljubljana, Ljubljana, Slovenia.
authors.forename: Helena Ban
authors.initials: HB
authors.lastname: Frangež
authors.affiliation: Department of Gynecology and Obstetrics, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Andrea
authors.initials: A
authors.lastname: Romano
mesh_terms: D004717:Endometrium / Q000187:drug effects* / Q000473:pathology; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D009277:Nandrolone / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: C023635:dienogest; D009277:Nandrolone
keywords: Dienogest; Endometrial thinning; Hysteroscopy; Pretreatment