EndoPelvic - Centro Multidisciplinar de Endometriose

Long-term administration of dienogest reduces recurrence after excision of endometrioma

Journal of Endometriosis 2015; 7(2): 63 - 67


Yoshiaki Ota, Masaaki Andou, Shiori Yanai, Saori Nakajima, Mika Fukuda, Mizuki Takano, Shozo Kurotsuchi, Keiko Ebisawa, Tomonori Hada, Ikuko Ota

Corresponding author

  • Yoshiaki Ota
    Kurashiki Medical Center, Department of Obstetrics and Gynecology
    250 Bakurochou
    Kurashiki City, Okayama Prefecture 710-8522, Japan
    [email protected]



Pain-relieving effects of dienogest against endometriosis are comparable to leuprolide acetate for 24 weeks. We assessed whether long-term dienogest administration reduces recurrence after endometrioma excision.


In this retrospective cohort study, 568 women with MRI-based diagnosis of ovarian endometrioma, who underwent laparoscopic stripping between 2008 and 2013, were studied. Recurrence rates and side effects over 5 years were investigated in 417 without postoperative medication and 151 who received dienogest postoperatively at 2 mg. Transvaginal sonography was performed every 3 months, and when cystic lesions ≥2 cm were observed, diagnostic MRI was conducted. Recurrence was defined as a lesion previously diagnosed as endometrioma by MRI, equal in size or larger 3 months later on ultrasonography. Cumulative recurrence rates were calculated with the Kaplan-Meier method, and group comparison involved log-rank tests. Blood examinations were completed every 3 months, and bone mineral density was measured with DEXA every 6 months.


Cumulative recurrence rates at the 5th postoperative year in the no-postoperative-medication and 2-mg dienogest groups were 69 and 4%, respectively, showing significant decreases (odd ratio [OR] = 0.09, 95% confidence interval, 0.03-0.26). Anemia occurred in 4% due to metrorrhagia directly after administration, metrorrhagia including spotting was observed in 20% at 1 year and decreases in bone mineral density and depression were observed in 4 and 2.6%, respectively, in the dienogest group.


Dienogest significantly prevented postoperative endometrioma recurrence. However, side effects such as metrorrhagia and a decreased bone mineral density were observed. Therefore, careful long-term follow-up is necessary.

Article History

  • Accepted on 09/06/2015
  • Available online on 24/06/2015
  • Published in print on 22/07/2015


Financial support: None.
Conflict of interest: The authors report no declarations of interest.

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