Obstetrics and Gynecology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Arch Gynecol Obstet. 2023 Sep;308(3):947-952. doi: 10.1007/s00404-023-07015-7. Epub 2023 Apr 3.
To compare the effectiveness of dienogest (DIE) and norethisterone acetate (NETA) regimens in the treatment of endometrial hyperplasia (EH) without atypia.
Participants were premenopausal women with irregular uterine bleeding, and endometrial hyperplasia without atypia on endometrial biopsy. Enrolled patients were randomly allocated into two groups: group I got DIE 2 mg/day (orally Visanne) for 14 days (10th to the 25th day of cycle) while group II received between the 16th and 25th day of the cycle, norethisterone acetate (NETA) 15 mg/d (orally Primolut Nor) was administered for 10 days. Both groups continued the therapy for six months.
The DIE group showed a higher resolution (32.7%) and regression (57.7%) than NETA group (31% & 37.9%, respectively) with significant regression (p = 0.039). No progression in DIE group while four (6.9%) women in NETA group were recorded a progression to complex type without a significance. Also, NETA group showed a significant persistence rate (22.5%) than DIE group (3.8%) (p = 0.005). Also number in NETA group managed by hysterectomy with significant difference (p = 0.042).
If used as first-line treatment, Dienogest produces a better rate of regression and a lower incidence of hysterectomy than Norethisterone Acetate does when used in EH without atypia.
比较地诺孕素（DIE）和醋酸炔诺酮（NETA）方案治疗不伴非典型子宫内膜增生（EH）的疗效。
参与者为有不规则子宫出血的绝经前妇女，子宫内膜活检显示不伴非典型的子宫内膜增生。入组患者被随机分为两组：I 组服用地诺孕素 2mg/天（口服维散宁），连用 14 天（周期第 10 天至第 25 天）；II 组在周期第 16 天至第 25 天服用醋酸炔诺酮 15mg/d（口服普美孕酮），连用 10 天。两组均继续治疗 6 个月。
DIE 组的缓解率（32.7%）和消退率（57.7%）均高于 NETA 组（分别为 31%和 37.9%），且消退有显著差异（p=0.039）。DIE 组无进展，而 NETA 组有 4 例（6.9%）进展为复杂性增生，无统计学意义。此外，NETA 组的持续率（22.5%）明显高于 DIE 组（3.8%）（p=0.005）。NETA 组行子宫切除术的人数也明显多于 DIE 组（p=0.042）。
如果作为一线治疗，地诺孕素治疗不伴非典型的子宫内膜增生的缓解率更高，且需要子宫切除术的比例低于醋酸炔诺酮。
