Within your body, there are various sex hormones, and one of them is progesterone, also known as the corpus luteum hormone. It plays a vital role in your organism by preparing the uterine lining each month for a possible fertilized egg. This preparation facilitates the implantation and growth of a new life in the uterus. During this process, the uterine lining undergoes remodeling and received improved blood supply. Additionally, progesterone has an effect on the endometrium by reducing the number of estrogen receptors and acting as an anti-estrogenic agent [2].
Let me delve deeper into this concept. Receptors are essential for communication within the body, as they relay signals [3]. The reference to progesterone as an antagonist of estrogen is particularly significant. Estrogen, a sex hormone, is known to promote the growth of endometriosis lesions. Hence, using progesterone to counteract the influence of estrogen proves to be a smart approach. This is where Dienogest comes to pay. It is a synthetic form of progesterone, also known as a progestogen, commonly used in medicine.
Let’s take a little historical excursion into the realm of endometriosis therapy. The journey to the current state of treatment was a progression over time. A pivotal milestone was the introduction of surgical interventions aimed at removing endometriosis lesions, which continue to be utilized today. Surprisingly, these surgical treatment options were developed as far back as the seventies and eighties. Before that, drug treatment primarily relied on a hormone called danazol [4, 5, 6]. However, this approach came with side effects, such as acne, weight gain, and the development of male body characteristics [7]. In the quest for alternative substances, researchers turned to progestins, among others, which showed great promise [8]. What makes progestins special is that they are derivatives of the body’s own corpus luteum hormone, resembling natural progesterone. This inherent similarity grants them a significant advantage – they can exert a comprehensive influence. Progestins not only act at the progesterone receptor but also interact with the estrogen receptor, androgen receptor, glucocorticoid receptor, and mineral corticoid receptor [9, 10].
After its discovery, Dienogest quickly garnered attention for endometriosis treatment due to its potent effects on the endometrium, the lining of the uterus. You might already be familiar with synthetically produced progestins used in the contraceptive pill. Progestins are not only used for contraception but also for pain relief and overall symptom improvement in endometriosis. The German Society of Gynecology and Obstetrics recommends suitable progestins as a preferred option for symptomatic drug treatment of endometriosis [1].
Specifically, Dienogest exhibits the following effects:
The undisputed efficacy of Dienogest in hormonal treatment warrants a closer look at why it can be helpful in endometriosis. To do so, we need to delve into the scientific literature. Studies conducted in test tubes and living organisms have revealed that Dienogest can inhibit uterine cell signaling [14]. This effect has been particularly observed in endometriosis cells located in the ovaries [15]. You may have come across the term “angiogenesis”, which refers to the formation of new blood vessels, distinct from existing ones. In studies, Dienogest has demonstrated the ability to slow down the formation of new blood vessels. This finding is critical as angiogenesis supplies endometriosis with nutrients, among other things [9].
This is why the term “drying up” is often used to describe the effects, although it is not entirely accurate. The foci themselves do not dry out, but the reduced supply of blood vessels and nutrients can make it more challenging for the endometriosis foci to grow and thrive.
Given that Dienogest is presently the sole progestogen officially approved for endometriosis, it is commonly prescribed in clinical practice. Let us delve into two studies that have investigated the effect of Dienogest in the context of endometriosis.
While hormonal treatments can provide relief from endometriosis, it is important to note that they do not cure the condition, nor do they guarantee the prevention of disease progression [16]. As a result, in some cases, surgery remains necessary, especially when sensitive structures like the ureter or intestine are affected [17, 18, 19]. A study was conducted to investigate the effect of Dienogest on women who had endometriosis lesions removed from their ovaries. The study group consisted of 203 patients, with an average age of 34.1 years. Following the surgical procedure, 90% of the patients took 2 mg of Dienogest daily for an average duration of 12 months. The observation period lasted about 30 months following surgery, during which the researcher monitored for adverse events and regrowth of endometriosis lesions [20].
Results: Results indicated that serious adverse side effects were not observed during the study, and endometriomas reappeared in only 3 patients [20].
Another study investigated the impact of Dienogest on endometriosis, with a specific focus on symptom improvement. The study group consisted of 100 patients diagnosed with endometriosis who had not yet reached menopause. These patients were divided into 3 groups [21]:
All study participants received 2 mg of Dienogest [21].
Results: Dienogest showed varying effects on the different groups of women. Hormonal treatment led to significant improvement in abdominal pain and quality of life for those who received the drug following surgery or who had not yet undergone surgery. However, patients who experienced a recurrence of endometriosis lesions after surgery did not benefit significantly from Dienogest [21].
Dienogest is a progestogen treatment that requires a prescription from your gynecologist. It is taken once a day, and the administration is similar to the use of the contraceptive pill. Typically, Dienogest is prescribed in a long cycle [12]. It is essential to closely cooperate with your gynecologist during the treatment of endometriosis. They will monitor the endometriosis lesions and determine the most suitable treatment plan for your specific case. This includes evaluating any potential side effects and determining if surgery may be advisable. Please note: It is important to note that Dienogest is not intended for contraception, but is specifically approved for the treatment of endometriosis [1]. Based on studies and empirical evidence from practice, a dosage of 2 mg of Dienogest is often recommended, as it has shown promising results with manageable side effects [22, 23].
When taking Dienogest, ovulation is typically suppressed, which prevents pregnancy from occurring. However, it is essential to know that your general fertility is not adversely affected by the drug. If you have a desire to have a child, it is crucial to discuss this with your gynecologist. They can tailor the therapy accordingly to accommodate your plans for pregnancy.
Dienogest intervenes in the hormonal composition of your body, which is beneficial in the case of endometriosis, as it counteracts the effects of the sex hormone estrogen, known to accelerate endometriosis growth. However, being a drug, Dienogest may come with some side effects, though they are not experienced by everyone.
Potential side effects include:
While Dienogest may be a suitable treatment option for patients with endometriosis, it is important to remember that not everyone experiences all of these side effects. Many women have little or no side effects. Additionally, when considering reports from social media, it is essential to be aware that those who comment are often individuals who may have experienced certain side effects.
To find the most appropriate treatment for you, it is best to discuss your specific situation with your gynecologist. If Dienogest is recommended, try it out with an open mind, and if any side effects occur, discuss them promptly with your gynecologist for proper management.
The drug Dienogest has been associated with a potential negative effect on bone density. As a result, adolescent women (teenagers) should approach the use of Dienogest with careful consideration in consultation with their doctor. Since bones are still growing during adolescence, it is crucial to assess the individual risk of osteoporosis (the risk of bone loss) before considering Dienogest as a treatment option [24].
Endometriosis can be influenced by estrogen, but progesterone can counteract its effects. Artificial luteal hormones such as Dienogest are considered pioneers in the hormonal treatment of endometriosis. Studies and real-world experience have shown that Dienogest can effectively reduce endometriosis lesions, alleviate pain, and lower the risk of new lesions by interfering with signaling pathways and inhibiting new blood vessel formation. Commonly, 2 mg of Dienogest is taken in a long-term cycle. Side effects may include irregular bleeding, headaches, and skin issues. Since Dienogest selectively affects the hormone balance, it requires a prescription and should be discussed with your gynecologist.
The Endo-App provides further information on treatment options and helpful tips for living with endometriosis. Download the Endo-App to access expert knowledge and support.
Psychologist Teresa Götz (Endo-App) interviewed Dr. Cecilia Ng, who is doing research on endometriosis in…
Psychologist Teresa Götz (Endo-App) interviewed Dr. Cecilia Ng, who is doing research on endometriosis in…
Psychologist Teresa Götz (Endo-App) interviewed Dr. Cecilia Ng, who is doing research on endometriosis in…
Psychologist Teresa Götz (Endo-App) interviewed Dr. Cecilia Ng, who is doing research on endometriosis in…
Psychologist Teresa Götz (Endo-App) interviewed Dr. Cecilia Ng, who is doing research on endometriosis in…
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