INTEGRATED MANAGEMENT OF OVARIAN ENDOMETRIOMAS: PRE- AND POST-SURGICAL USE OF DIENOGEST

Area of Science:

• Reproductive Endocrinology
• Surgical Gynecology

Background:

• Ovarian endometriomas are associated with infertility and high recurrence rates after surgery.
• Current management strategies often involve surgical intervention, but recurrence remains a challenge.

Purpose of the Study:

• To evaluate the efficacy of an integrated management approach for ovarian endometriomas.
• To assess the impact of Dienogest, administered pre- and post-operatively, on reproductive outcomes and recurrence rates in infertile women.

Main Methods:

• A prospective, comparative clinical trial involving 44 infertile women with ovarian endometriomas.
• Patients were randomized into a study group (Dienogest + surgery) and a control group (surgery alone).
• Outcomes included cyst size, anti-Müllerian hormone (AMH), antral follicle count (AFC), pregnancy rates, and endometrioma recurrence over 1 year.

Main Results:

• The Dienogest group showed reduced cyst size, stable AMH and AFC levels, a 65% pregnancy rate, and 15% recurrence at 1 year.
• The control group experienced significantly lower AMH and AFC levels post-surgery, a 29.2% pregnancy rate, and a high recurrence rate of 79.2%.

Conclusions:

• Integrated management with Dienogest before and after laparoscopic surgery is effective for ovarian endometriomas in infertile women.
• This approach improves reproductive outcomes and significantly reduces endometrioma recurrence.
• Dienogest administration helps preserve ovarian reserve markers (AMH, AFC) compared to surgery alone.