Dienogest in the treatment of endometriosis
Abstract
INTRODUCTION: Dienogest (DNG) is an oral progestin, derivative of 19-nortestosterone, that has recently been introduced for the treatment of endometriosis. AREAS COVERED: This review examines the clinical efficacy, safety and tolerability of DNG in the treatment of endometriosis. The material included in the current manuscript was searched and obtained via Medline, Pubmed and EMBASE, from inception until February 2014. The term 'dienogest' was associated with the following search terms: 'endometriosis', 'pharmacokinetics', 'safety' and 'efficacy'. EXPERT OPINION: Several trials demonstrated the clinical efficacy, safety and tolerability of DNG. However the use of DNG is associated with some limitations. So far, no study investigated the potential of contraceptive effect of this treatment and therefore, it should be recommended with other methods of contraception (e.g., barrier methods). A further limitation of the use of DNG as daily therapy in the long term is that the cost of the therapy is higher than other progestins available on the market and combined oral contraceptives. Therefore, future studies should be designed to compare the efficacy and safety of DNG with other progestins.
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During DNG 2 mg/d, average estradiol serum levels remain 20-50 pg/ml, which should prevent BMD loss and avoid endometriotic lesion growth.
“However, during DNG treatment (at a daily dose of 2 mg) the average estradiol (E 2 ) serum levels remain in the range of 20-50 pg/ml; this E 2 serum concentration should, at the same time, prevent bone mineral density (BMD) loss and avoid endometriotic lesions growth [22].”
From Oral and depot progestin therapy for endometriosis: towards a personalized medicine (2017) · cites this paper as [22]
DNG at 2 mg/d inhibits gonadotropin production with decrease in endogenous estradiol, establishing a hypoestrogenic and hyperprogestinic environment that stimulates initial decidualization and subsequent atrophy of endometriotic lesions.
“When administered at the dosage indicated for the management of endometriosis (2 mg/d), DNG inhibits the production of gonadotropin with a decrease in the endogenous release of estradiol, with the establishment of a hypoestrogenic and hyperprogestinic environment that stimulates initial decidualization and subsequent atrophy of endometriotic lesions [22].”
From Oral and depot progestin therapy for endometriosis: towards a personalized medicine (2017) · cites this paper as [22]
DNG exerts strong antiandrogenic properties and has no glucocorticoid or mineralocorticoid effects.
“Moreover, DNG exerts strong antiandrogenic properties, whereas it has no glucocorticoid nor mineral corticoid effects [22,23].”
From Oral and depot progestin therapy for endometriosis: towards a personalized medicine (2017) · cites this paper as [22]
Overall, DNG is a well-tolerated drug with a rate of discontinuation related to adverse reactions <5%.
“Overall, DNG is a well-tolerated drug with a rate of discontinuation related to adverse reactions <5% [22].”
From Oral and depot progestin therapy for endometriosis: towards a personalized medicine (2017) · cites this paper as [22]
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References 58 · Cited by 63
- Authors
- Bizzarri, N., Remorgida, V., Leone Roberti Maggiore, U., Scala, C., Tafi, E., Ghirardi, V., Salvatore, S., Candiani, M., Venturini, P. L., & Ferrero, S.
- Affiliations
- Ospedale Policlinico San Martino (IT)
- Vita-Salute San Raffaele University (IT)
- ORCID
- Venue
- Expert Opinion on Pharmacotherapy
- Publisher
- Informa Healthcare
- Published
- 2014-07-29
- Volume
- 15
- Issue
- 13
- Pages
- 1889-1902
- ISSN
- 1465-6566 (ISSN-L)
- 1744-7666
- OpenAlex
- W2036135854
- Semantic Scholar
- f7b7ed0133612d7d108125cfa07d156e296d2761
- Cited by
- 63
- References
- 58
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 7 · 2023: 19 · 2022: 1 · 2021: 1 · 2020: 4 · 2019: 2 · 2018: 5 · 2017: 5 · 2016: 5 · 2015: 5 · 2014: 1
- FWCI
- 0.83
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Expert Opinion on Pharmacotherapy (publishedVersion)
- PubMed (publishedVersion)
- CINECA IRIS Institutial Research Information System (University of Genoa) (submittedVersion)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Keywords
- dienogest, endometriosis, oral progestogens, 19-nortestosterone derivatives, pharmacokinetics, drug safety and tolerability, clinical efficacy, contraceptive effect, long-term treatment, treatment costs
- MeSH terms
- Administration, Oral, Clinical Trials as Topic, Endometriosis, Female, Humans, Nandrolone, Progestins
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