Long-term medical management of endometriosis with dienogest and with a gonadotropin-releasing hormone agonist and add-back hormone therapy

Fertil Steril. 2017 Mar;107(3):537-548. doi: 10.1016/j.fertnstert.2016.12.024. Epub 2017 Jan 27.

Abstract

Endometriosis can recur after either surgical or medical therapy. Long-term medical therapy is implemented to treat symptoms or prevent recurrence. Dienogest and gonadotropin-releasing hormone (GnRH) analogues with hormone add-back therapy seem to be equally effective for long-term treatment of pain symptoms associated with endometriosis. There is insufficient evidence to support the superiority of one therapy over the other. However, add-back hormone therapy (HT) is recommended for patients using GnRH agonists. The treatment selection depends on therapeutic effectiveness, tolerability, drug cost, the physician's experience, and expected patient compliance.

Keywords: Dienogest; GnRH-a; endometriosis; hormone add-back; long term.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Contraceptives, Oral, Combined / administration & dosage*
  • Contraceptives, Oral, Combined / adverse effects
  • Contraceptives, Oral, Combined / economics
  • Cost-Benefit Analysis
  • Drug Costs
  • Drug Therapy, Combination
  • Endometriosis / diagnosis
  • Endometriosis / drug therapy*
  • Endometriosis / economics
  • Endometriosis / physiopathology
  • Endometrium / drug effects*
  • Endometrium / pathology
  • Endometrium / physiopathology
  • Female
  • Gonadotropin-Releasing Hormone / agonists*
  • Humans
  • Medication Adherence
  • Nandrolone / administration & dosage
  • Nandrolone / adverse effects
  • Nandrolone / analogs & derivatives*
  • Nandrolone / economics
  • Pelvic Pain / diagnosis
  • Pelvic Pain / drug therapy*
  • Pelvic Pain / economics
  • Pelvic Pain / physiopathology
  • Progestins / administration & dosage*
  • Progestins / adverse effects
  • Progestins / economics
  • Recurrence
  • Treatment Outcome
  • Young Adult

Substances

  • Contraceptives, Oral, Combined
  • Progestins
  • Gonadotropin-Releasing Hormone
  • dienogest
  • Nandrolone