Karataş Esra, Temiz Bilal Esat, Mümüşoğlu Sezcan, Yaralı Hakan, Bozdağ Gürkan
Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Anatolia In Vitro Fertilization and Women Health Centre, Ankara, Turkey.
J Turk Ger Gynecol Assoc. 2024 Jun 13;25(2):102-106. doi: 10.4274/jtgga.galenos.2024.2022-9-4.
To assess the effect of dienogest treatment on endometrioma (OMA) size, serum anti-Mullerian hormone (AMH) levels and associated pain over a 12-month follow-up period.
A longitudinal cohort study of 104 patients with OMA who were treated with dienogest, between January 2017 and January 2020. Of the included patients, each had a 12-month follow-up period with transvaginal or pelvic ultrasound and measurement of serum AMH concentration at the sixth and twelfth months of follow-up. The alteration in OMA size in the sixth and twelfth months of treatment was the primary outcome measure and the alteration in AMH concentration over the same period was the secondary outcome measure. The only exclusion criterion was having surgical intervention for OMA during the follow-up period (n=44). In patients with bilateral OMA (n=21), the change in size of the largest OMA was considered in the analysis.
A total of 60 patients with a mean ± standard deviation (SD) age of 31.5±8.0 years were included. The mean ± SD OMA size on the day the dienogest was started was 46.3±17.4 mm and the mean AMH level was 3.6±2.4 ng/mL. After six months, the mean OMA size had decreased to 38.6±14.0 mm, with a median difference of 7.8 mm [95% confidence interval (CI): 3.0 to 12.6; p=0.003]. The mean AMH level was 3.3±2.7 ng/mL at 6 months follow-up (95% CI: -0.2 to 0.8; p=0.23) and the average difference was 0.3 ng/mL. At the 12-month visit, when compared with the beginning of the treatment, OMA size had again significantly decreased by a median of -8.9 mm (95% CI: -2.9 to -14.9; p=0.005), and the decline in median AMH was also significant (-0.9 ng/mL, 95% CI: -0.1 to -1.7; p=0.045). The initial mean ± SD visual analog scale pain score at the commencement of dienogest treatment was 6.3±3.4. The mean values at the sixth and twelfth months of dienogest therapy were 1.08±1.8 and 0.75±1.5, respectively (both p<0.001 compared to baseline).
At the sixth and twelfth months of dienogest treatment a significant decrease in OMA size and reported pain scores were observed, whereas the AMH concentrations did not change significantly.
评估地诺孕素治疗在12个月随访期内对卵巢子宫内膜异位囊肿（OMA）大小、血清抗苗勒管激素（AMH）水平及相关疼痛的影响。
对2017年1月至2020年1月期间接受地诺孕素治疗的104例OMA患者进行纵向队列研究。纳入的患者均有12个月的随访期，在随访的第6个月和第12个月进行经阴道或盆腔超声检查并测定血清AMH浓度。治疗第6个月和第12个月时OMA大小的变化为主要观察指标，同期AMH浓度的变化为次要观察指标。唯一的排除标准是在随访期间接受过OMA手术干预（n = 44）。对于双侧OMA患者（n = 21），分析时考虑最大OMA大小的变化。
共纳入60例患者，平均年龄为31.5±8.0岁（均值±标准差）。开始使用地诺孕素当天OMA的平均大小为46.3±17.4 mm，平均AMH水平为3.6±2.4 ng/mL。6个月后，OMA平均大小降至38.6±14.0 mm，中位数差异为7.8 mm [95%置信区间（CI）：3.0至12.6；p = 0.003]。随访6个月时平均AMH水平为3.3±2.7 ng/mL（95% CI：-0.2至0.8；p = 0.23），平均差异为0.3 ng/mL。在12个月随访时，与治疗开始时相比，OMA大小再次显著下降，中位数为-8.9 mm（95% CI：-2.9至-14.9；p = 0.005），AMH中位数下降也显著（-0.9 ng/mL，95% CI：-0.1至-1.7；p = 0.045）。地诺孕素治疗开始时视觉模拟量表疼痛评分的初始均值±标准差为6.3±3.4。地诺孕素治疗第6个月和第12个月时的均值分别为1.08±1.8和0.75±1.5（与基线相比p均<0.001）。
在使用地诺孕素治疗的第6个月和第12个月，观察到OMA大小和报告的疼痛评分显著降低，而AMH浓度无显著变化。
