title: Dienogest and deep infiltrating endometriosis: The remission of symptoms is not related to endometriosis nodule remission.
abstract: OBJECTIVE
  To evaluate the effectiveness of dienogest in controlling pain caused by deep infiltrating endometriosis (DIE), its influence on the quality of live (QoL) of women affected by the disease, and the effect of the drug on the volume of endometriotic lesions.
  
  
  METHODS
  A prospective cohort study including 30 women with a sonographic diagnosis of DIE (intestinal and posterior fornix) treated with dienogest 2mg per day for 12 months. We evaluated the pain symptoms and the volume of the intestinal and posterior fornix lesions before and after 12 months of use of dienogest. To perform the statistical analysis, we used the Wilcoxon signed-rank test, and the relationship between the data was tested using the Spearman correlation coefficient.
  
  
  RESULTS
  Women were on average 36.13±6.24years old. Pain symptoms most commonly reported were dyspareunia (83.3%), dysmenorrhea (73.3%), and pelvic pain (66.7%). After 12 months of treatment with dienogest, there was significant improvement of various symptoms (dyspareunia p=0.0093, dysmenorrhea p<0.0001; pelvic pain p=0.0007; and bowel pain p<0.0001), without a reduction in the volume of endometriotic nodules. There were significant improvements in the parameters that comprise the QoL (physical p<0.0001; p=0.0007 psychological) and the self-assessment of QoL (p=0.0069) and health (p=0.0001).
  
  
  CONCLUSIONS
  Dienogest is an effective medication to control symptoms of pain related to DIE, even without reducing the volume of DIE nodules.
authors.affiliation: Department of Gynecology and Obstetrics, School of Medical Sciences, University of Campinas, (UNICAMP), Campinas, SP, Brazil.
authors.forename: Joao Paulo
authors.initials: JP
authors.lastname: Leonardo-Pinto
authors.affiliation: Department of Gynecology and Obstetrics, School of Medical Sciences, University of Campinas, (UNICAMP), Campinas, SP, Brazil.
authors.forename: Cristina Laguna
authors.initials: CL
authors.lastname: Benetti-Pinto
authors.affiliation: Department of Gynecology and Obstetrics, School of Medical Sciences, University of Campinas, (UNICAMP), Campinas, SP, Brazil.
authors.forename: Kleber
authors.initials: K
authors.lastname: Cursino
authors.affiliation: Department of Gynecology and Obstetrics, School of Medical Sciences, University of Campinas, (UNICAMP), Campinas, SP, Brazil. Electronic address: yela@unicamp.br.
authors.forename: Daniela Angerame
authors.initials: DA
authors.lastname: Yela
mesh_terms: D000328:Adult; D003248:Constipation / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D004715:Endometriosis / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006727:Hormone Antagonists / Q000627:therapeutic use*; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D009277:Nandrolone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010147:Pain Measurement; D017699:Pelvic Pain / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome
chemical_list: D006727:Hormone Antagonists; C023635:dienogest; D009277:Nandrolone
keywords: Clinical treatment; Deep infiltrating endometriosis; Dienogest; Pelvic pain; Quality of life