Comparison of effect of preoperative dienogest and gonadotropin-releasing hormone agonist administration on laparoscopic cystectomy for ovarian endometriomas

Arch Gynecol Obstet. 2020 Oct;302(4):969-976. doi: 10.1007/s00404-020-05691-3. Epub 2020 Jul 13.


Purpose: To compare the effects of preoperative dienogest (DNG) and gonadotropin-releasing hormone (GnRH) agonist administration on the improvement of preoperative symptoms and surgical outcomes in patients who underwent laparoscopic cystectomy for ovarian endometriomas.

Methods: Seventy patients who were scheduled for laparoscopic surgery were enrolled in the study. They were divided into two groups: 35 patients who received DNG for 4 months preoperatively (group D) and 35 patients who received low-dose sustained-release goserelin acetate for 4 months preoperatively (group G). Preoperative outcomes, including pain score associated with endometriosis, using the numerical rating scale (NRS), adverse events of hormonal therapy and Kupperman index (KI) before and after treatment, surgical outcomes including total surgical duration and blood loss, and postoperative recurrence of endometrioma were compared between the two groups.

Results: Regarding preoperative symptoms, NRS and KI at 4 months after preoperative hormonal therapy were significantly lower in group D than in group G (NRS, 5.3 ± 5.5 vs. 2.7 ± 3.9; P = 0.01; KI, 16.0 ± 11.0 vs. 9.2 ± 7.6; P = 0.006). Regarding adverse events, the incidence of hot flashes was significantly lower in group D than in group G (P < 0.001). Meanwhile, the incidence of breast pain and metrorrhagia was significantly higher in group D than in group G (P = 0.04 and P < 0.001, respectively). The total surgical duration and blood loss were not significantly different between the groups. At 12 months after surgery, ovarian endometrioma did not recur in either group.

Conclusion: Preoperative administration of DNG is more valuable for patients with endometriosis and scheduled for laparoscopic surgery to improve symptoms with good efficacy and tolerability than the administration of GnRH agonist.

Keywords: Dienogest; Endometrioma; GnRH agonist; Laparoscopic cystectomy; Preoperative medication.

MeSH terms

  • Adolescent
  • Adult
  • Contraceptives, Oral, Hormonal / pharmacology
  • Contraceptives, Oral, Hormonal / therapeutic use*
  • Cystectomy / methods*
  • Endometriosis / drug therapy*
  • Endometriosis / surgery*
  • Female
  • Gonadotropin-Releasing Hormone / pharmacology
  • Gonadotropin-Releasing Hormone / therapeutic use*
  • Hormone Antagonists / pharmacology
  • Hormone Antagonists / therapeutic use*
  • Humans
  • Laparoscopy / methods*
  • Middle Aged
  • Nandrolone / analogs & derivatives*
  • Nandrolone / pharmacology
  • Nandrolone / therapeutic use
  • Preoperative Period
  • Prospective Studies
  • Young Adult


  • Contraceptives, Oral, Hormonal
  • Hormone Antagonists
  • Gonadotropin-Releasing Hormone
  • dienogest
  • Nandrolone