Skip to main content

Advertisement

SpringerLink
Log in

Endometrial preparation with Dienogest before hysteroscopic surgery: a systematic review

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

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.

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Di Spiezio Sardo A, Bettocchi S, Spinelli M et al (2010) Review of new office-based hysteroscopic procedures 2003–2009. J Minim Invasive Gynecol 17:436–448. doi:10.1016/j.jmig.2010.03.014

    Article  Google Scholar 

  2. Gizzo S, Saccardi C, Di Gangi S et al (2014) Secondary amenorrhea in severe Asherman’s syndrome: step by step fertility retrieval by Bettocchi’s hysteroscope: some considerations. Minim Invasive Ther Allied Technol 23:115–119. doi:10.3109/13645706.2013.835736

    Article  PubMed  Google Scholar 

  3. Laganà AS, Ciancimino L, Mancuso A et al (2014) 3D sonohysterography vs hysteroscopy: a cross-sectional study for the evaluation of endouterine diseases. Arch Gynecol Obstet 290:1173–1178. doi:10.1007/s00404-014-3366-6

    Article  PubMed  Google Scholar 

  4. Sudano MC, Vitale SG, Rapisarda AMC et al (2015) The REP-b (removal of endometrial pathologies-basket) in-office hysteroscopy. Updates Surg. doi:10.1007/s13304-015-0294-3

    PubMed  Google Scholar 

  5. Bradley LD (2002) Complications in hysteroscopy: prevention, treatment and legal risk. Curr Opin Obstet Gynecol 14:409–415. doi:10.1097/00001703-200208000-00008

    Article  PubMed  Google Scholar 

  6. Kayatas S, Meseci E, Tosun OA et al (2014) Experience of hysteroscopy indications and complications in 5, 474 cases. Clin Exp Obstet Gynecol 41:451–454. doi:10.12891/ceog17502014

    CAS  PubMed  Google Scholar 

  7. Deffieux X, Gauthier T, Menager N et al (2013) Prevention of the complications related to hysteroscopy: guidelines for clinical practice. J Gynecol Obstet Biol Reprod (Paris) 42:1032–1049. doi:10.1016/j.jgyn.2013.09.008

    Article  CAS  Google Scholar 

  8. Shveiky D, Rojansky N, Revel A et al (2007) Complications of hysteroscopic surgery: “Beyond the learning curve”. J Minim Invasive Gynecol 14:218–222. doi:10.1016/j.jmig.2006.07.019

    Article  PubMed  Google Scholar 

  9. Giacobbe V, Rossetti D, Vitale SG et al (2016) Otorrhagia and nosebleed as first signs of intravascular absorption syndrome during hysteroscopy: from bench to bedside. Kathmandu Univ Med J 14:87–89

    CAS  Google Scholar 

  10. Rai VS, Gillmer MDG, Gray W (2000) Is endometrial pre-treatment of value in improving the outcome of transcervical resection of the endometrium? Hum Reprod 15:1989–1992

    Article  CAS  PubMed  Google Scholar 

  11. Parazzini F, Vercellini P, De Giorgi O et al (1998) Efficacy of preoperative medical treatment in facilitating hysteroscopic endometrial resection, myomectomy and metroplasty: Literature review. Hum Reprod 13:2592–2597. doi:10.1093/humrep/13.9.2592

    Article  CAS  PubMed  Google Scholar 

  12. Florio P, Filippeschi M, Imperatore A et al (2012) The practicability and surgeons’ subjective experiences with vaginal danazol before an operative hysteroscopy. Steroids 77:528–533. doi:10.1016/j.steroids.2012.01.017

    Article  CAS  PubMed  Google Scholar 

  13. Cicinelli E, Pinto V, Tinelli R et al (2007) Rapid endometrial preparation for hysteroscopic surgery with oral desogestrel plus vaginal raloxifene: a prospective, randomized pilot study. Fertil Steril 88:698–701. doi:10.1016/j.fertnstert.2006.11.151

    Article  CAS  PubMed  Google Scholar 

  14. Bifulco G, Di Spiezio Sardo A, De Rosa N et al (2012) The use of an oral contraceptive containing estradiol valerate and dienogest before office operative hysteroscopy: a feasibility study. Gynecol Endocrinol 28:949–955. doi:10.3109/09513590.2012.683078

    Article  CAS  PubMed  Google Scholar 

  15. Tan YH, Lethaby A (2013) Pre-operative endometrial thinning agents before endometrial destruction for heavy menstrual bleeding. Cochrane Database Syst Rev. doi:10.1002/14651858.CD010241.pub2

    Google Scholar 

  16. Triolo O, De Vivo A, Benedetto V et al (2006) Gestrinone versus danazol as preoperative treatment for hysteroscopic surgery: a prospective, randomized evaluation. Fertil Steril 85:1027–1031. doi:10.1016/j.fertnstert.2005.09.034

    Article  CAS  PubMed  Google Scholar 

  17. Laganà AS, Palmara V, Granese R et al (2014) Desogestrel versus danazol as preoperative treatment for hysteroscopic surgery: a prospective, randomized evaluation. Gynecol Endocrinol 30:794–797. doi:10.3109/09513590.2014.929658

    Article  PubMed  Google Scholar 

  18. Shin D, Lee S, Lim KS et al (2013) Pharmacokinetic study of single and multiple oral administrations of 2 mg dienogest in healthy Korean women. Contraception 87:750–755. doi:10.1016/j.contraception.2012.10.033

    Article  CAS  PubMed  Google Scholar 

  19. Zeun S, Lu M, Uddin A et al (2009) Pharmacokinetics of an oral contraceptive containing oestradiol valerate and dienogest. Eur J Contracept Reprod Health Care 14:221–232. doi:10.1080/13625180902850039

    Article  CAS  PubMed  Google Scholar 

  20. Strowitzki T, Faustmann T, Gerlinger C et al (2015) Safety and tolerability of dienogest in endometriosis: pooled analysis from the European clinical study program. Int J Womens Health 7:393–401. doi:10.2147/IJWH.S77202

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Mori T, Ito F, Matsushima H et al (2015) Dienogest reduces HSD17β1 expression and activity in endometriosis. J Endocrinol 225:69–76. doi:10.1530/JOE-15-0052

    Article  CAS  PubMed  Google Scholar 

  22. Sofo V, Götte M, Laganà AS et al (2015) Correlation between dioxin and endometriosis: an epigenetic route to unravel the pathogenesis of the disease. Arch Gynecol Obstet. doi:10.1007/s00404-015-3739-5

    Google Scholar 

  23. Miyashita M, Koga K, Takamura M et al (2014) Dienogest reduces proliferation, aromatase expression and angiogenesis, and increases apoptosis in human endometriosis. Gynecol Endocrinol 3590:1–5. doi:10.3109/09513590.2014.911279

    Google Scholar 

  24. Vetvicka V, Laganà AS, Salmeri FM et al (2016) Regulation of apoptotic pathways during endometriosis: from the molecular basis to the future perspectives. Arch Gynecol Obstet. doi:10.1007/s00404-016-4195-6

    PubMed  Google Scholar 

  25. Laganà AS, Triolo O, Salmeri FM et al (2016) Natural Killer T cell subsets in eutopic and ectopic endometrium: a fresh look to a busy corner. Arch Gynecol Obstet 293:941–949. doi:10.1007/s00404-015-4004-7

    Article  PubMed  Google Scholar 

  26. Angioni S, Cofelice V, Pontis A et al (2014) New trends of progestins treatment of endometriosis. Gynecol Endocrinol 30:769–773. doi:10.3109/09513590.2014.950646

    Article  CAS  PubMed  Google Scholar 

  27. Bizzarri N, Remorgida V, Leone Roberti Maggiore U et al (2014) Dienogest in the treatment of endometriosis. Expert Opin Pharmacother 15:1889–1902. doi:10.1517/14656566.2014.943734

    Article  CAS  PubMed  Google Scholar 

  28. Maniglio P, Ricciardi E, Laganà AS et al (2016) Epigenetic modifications of primordial reproductive tract: a common etiologic pathway for Mayer–Rokitansky–Kuster–Hauser Syndrome and endometriosis? Med Hypotheses 90:4–5. doi:10.1016/j.mehy.2016.02.015

    Article  CAS  PubMed  Google Scholar 

  29. Petraglia F, Hornung D, Seitz C et al (2012) Reduced pelvic pain in women with endometriosis: efficacy of long-term Dienogest treatment. Arch Gynecol Obstet 285:167–173. doi:10.1007/s00404-011-1941-7

    Article  PubMed  Google Scholar 

  30. Triolo O, Laganà AS, Sturlese E (2013) Chronic pelvic pain in endometriosis: an overview. J Clin Med Res 5:153–163

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Laganà AS, Vitale SG, Trovato MA et al (2016) Full-thickness excision versus shaving by laparoscopy for intestinal deep infiltrating endometriosis: rationale and potential treatment options. Biomed Res Int 2016:1–8. doi:10.1155/2016/3617179

    Article  Google Scholar 

  32. White K, Potter JE, Hopkins K et al (2012) Contraindications to progestin-only oral contraceptive pills among reproductive-aged women. Contraception 86:199–203. doi:10.1016/j.contraception.2012.01.008

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Hall KS, Trussell J, Schwarz EB (2012) Progestin-only contraceptive pill use among women in the United States. Contraception 86:653–658. doi:10.1016/j.contraception.2012.05.003

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Sugimoto K, Nagata C, Hayashi H et al (2015) Use of dienogest over 53 weeks for the treatment of endometriosis. J Obstet Gynaecol Res 41:1921–1926. doi:10.1111/jog.12811

    Article  PubMed  Google Scholar 

  35. de Andres MP, Lopes LA, Baracat EC, Podgaec S (2015) Dienogest in the treatment of endometriosis: systematic review. Arch Gynecol Obstet 292:523–529. doi:10.1007/s00404-015-3681-6

    Article  CAS  Google Scholar 

  36. Schindler AE (2011) Dienogest in long-term treatment of endometriosis. Int J Womens Health 3:175–184. doi:10.2147/IJWH.S5633

    Article  PubMed  PubMed Central  Google Scholar 

  37. Laganà AS, Giacobbe V, Triolo O et al (2016) Dienogest as preoperative treatment of submucous myomas for hysteroscopic surgery: a prospective, randomized study. Gynecol Endocrinol 32:408–411. doi:10.3109/09513590.2015.1128409

    Article  PubMed  Google Scholar 

  38. Zorzela L, Loke YK, Ioannidis JP et al (2016) PRISMA harms checklist: improving harms reporting in systematic reviews. BMJ 352:i157. doi:10.1136/bmj.i157

    Article  PubMed  Google Scholar 

  39. Kodama M, Onoue M, Otsuka H et al (2013) Efficacy of Dienogest in thinning the endometrium before hysteroscopic surgery. J Minim Invasive Gynecol 20:790–795. doi:10.1016/j.jmig.2013.04.020

    Article  PubMed  Google Scholar 

  40. Cicinelli E, Pinto V, Quattromini P et al (2012) Endometrial preparation with estradiol plus Dienogest (Qlaira) for office hysteroscopic polypectomy: randomized pilot study. J Minim Invasive Gynecol 19:356–359. doi:10.1016/j.jmig.2011.12.020

    Article  PubMed  Google Scholar 

  41. Tsuchiya T, Katagiri Y, Maemura T et al (2016) Preoperative dienogest to improve the surgical field of view in resectoscopic surgery. Gynecol Minim Invasive Ther 5:16–19. doi:10.1016/j.gmit.2015.01.011

    Article  Google Scholar 

  42. Banno K, Kisu I, Yanokura M et al (2012) Progestin therapy for endometrial cancer: the potential of fourth-generation progestin (Review). Int J Oncol 40:1755–1762. doi:10.3892/ijo.2012.1384

    CAS  PubMed  Google Scholar 

  43. Saito F, Tashiro H, Yamaguchi M et al (2016) Development of a mouse model for testing therapeutic agents: the anticancer effect of dienogest on endometrial neoplasms. Gynecol Endocrinol 32:403–407. doi:10.3109/09513590.2015.1124411

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy

    Antonio Simone Laganà, Salvatore Giovanni Vitale, Onofrio Triolo, Vittorio Palmara & Roberta Granese

  2. Unit of Diabetology and Endocrino-Metabolic Diseases, Hospital for Emergency Cannizzaro, Catania, Italy

    Vincenzo Muscia, Paola Rossetti & Massimo Buscema

  3. Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy

    Agnese Maria Chiara Rapisarda

  4. Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy

    Loretta Giunta

  5. Department of Reproduction, University Medical Center Ljubljana, Ljubljana, Slovenia

    Helena Ban Frangež

  6. Department of Gynecology and Obstetrics, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands

    Andrea Romano

Authors
  1. Antonio Simone Laganà
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Salvatore Giovanni Vitale
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vincenzo Muscia
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paola Rossetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Massimo Buscema
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Onofrio Triolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Agnese Maria Chiara Rapisarda
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Loretta Giunta
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Vittorio Palmara
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Roberta Granese
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Helena Ban Frangež
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Andrea Romano
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Antonio Simone Laganà.

Ethics declarations

Funding

The work was not supported by any Grant/fund.

Conflict of interest

The authors have no proprietary, financial, professional or other personal interest of any nature in any product, service or company. The authors alone are responsible for the content and writing of the paper.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Laganà, A.S., Vitale, S.G., Muscia, V. et al. Endometrial preparation with Dienogest before hysteroscopic surgery: a systematic review. Arch Gynecol Obstet 295, 661–667 (2017). https://doi.org/10.1007/s00404-016-4244-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-016-4244-1

Keywords

Search

Navigation