Department of Obstetrics and Gynaecology, Kanazawa Medical University, School of Medicine, Japan.
Department of Obstetrics and Gynaecology, Kanazawa Medical University, School of Medicine, Japan.
Taiwan J Obstet Gynecol. 2023 Nov;62(6):852-857. doi: 10.1016/j.tjog.2023.08.003.
Dienogest (DNG), a fourth-generation progestin, reduces pain associated with endometriosis and uterine adenomyosis; however, it is associated with irregular uterine bleeding that can cause anemia and poor quality of life. We investigated risk factors for heavy bleeding following DNG administration.
We retrospectively investigated patients who received DNG for risk factors of heavy uterine bleeding, including clinical diagnosis, use of pretreatment gonadotropin-releasing hormone agonist, smoking, cancer antigen 125, and blood hormone levels. We additionally assessed the uterine area in patients with uterine adenomyosis, the major axis of the uterine body, the major axis of myometrial thickness, the site of tumor development, and the site of myoma development in patients with uterine fibroids.
Eighty Japanese patients were administered DNG. The median age was 41 (range: 24-51) years. The odds ratio (OR) for moderate-to-severe bleeding according to clinical diagnosis were 0.33 (P = 0.011) for endometrioma and 9.00 (P = 0.049) for uterine adenomyosis. Receiver operating characteristic curve analysis of the uterine area associated with uterine adenomyosis showed an area under the curve (AUC) of 0.909 between those with major and minor bleeding, with an optimal cut-off value of 7388.2 mm. The uterine body major axis had an AUC of 0.946, with an optimal cut-off value of 78.3 mm. The major axis of myometrial thickness had an AUC of 0.855, with an optimal cut-off value of 46.8 mm.
Patients with endometrioma treated with DNG were less likely to experience heavy uterine bleeding. Uterine bleeding in patients with uterine adenomyosis and adenomyosis associated with uterine fibroids should be closely monitored while administering DNG.
地诺孕素（DNG）是一种第四代孕激素，可减轻子宫内膜异位症和子宫腺肌病相关的疼痛；然而，它与不规则子宫出血相关，可导致贫血和生活质量下降。我们研究了 DNG 给药后发生大出血的相关危险因素。
我们回顾性调查了接受 DNG 治疗的患者，以评估与大出血相关的风险因素，包括临床诊断、预处理促性腺激素释放激素激动剂的使用、吸烟、癌抗原 125 和血液激素水平。此外，我们还评估了子宫腺肌病患者的子宫面积、子宫体的长轴、子宫肌层厚度的长轴、肿瘤发生部位和子宫肌瘤发生部位。
80 例日本患者接受 DNG 治疗。中位年龄为 41 岁（范围：24-51 岁）。根据临床诊断，中重度出血的优势比（OR）为子宫内膜异位瘤患者为 0.33（P=0.011），子宫腺肌病患者为 9.00（P=0.049）。与子宫腺肌病相关的子宫面积的受试者工作特征曲线分析显示，大出血和少量出血患者之间的曲线下面积（AUC）为 0.909，最佳截断值为 7388.2mm。子宫体长轴的 AUC 为 0.946，最佳截断值为 78.3mm。子宫肌层厚度的长轴的 AUC 为 0.855，最佳截断值为 46.8mm。
DNG 治疗的子宫内膜异位瘤患者发生重度子宫出血的可能性较小。在给予 DNG 治疗时，应密切监测子宫腺肌病患者和与子宫腺肌病相关的子宫肌瘤患者的出血情况。
