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Современный менеджмент эндометриоза: применение диеногеста при разных формах его проявления
Современный менеджмент эндометриоза: применение диеногеста при разных формах его проявления
Чернуха Г.Е., Пронина В.А., Солопова А.Е. Современный менеджмент эндометриоза: применение диеногеста при разных формах его проявления. Гинекология. 2026;28(1):4–10. DOI: 10.26442/20795696.2026.1.203570
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Аннотация
Обоснование. Эндометриоз – хроническое рецидивирующее заболевание, требующее длительной медикаментозной терапии, особенно при отсутствии репродуктивных планов. Диеногест (ДНГ) считается препаратом терапии 1-й линии благодаря комплексному механизму действия. Однако недостаточно исследований, объективно оценивающих динамику эндометриоидных очагов с помощью магнитно-резонансной томографии (МРТ) на фоне терапии ДНГ. Необходимость в таких данных, включая оценку влияния на болевой синдром (БС) и овариальный резерв, определяет актуальность исследования.
Цель. Оценить динамику эндометриоидных очагов, интенсивности БС и показателей овариального резерва у пациенток с эндометриозом на фоне терапии ДНГ.
Материалы и методы. Проведено проспективное исследование, включающее 71 женщину с эндометриозом (средний возраст – 32,1 года), подтвержденным на основании данных МРТ органов малого таза, которым не показано хирургическое лечение. Пациентки получали ДНГ 2 мг в сутки (Зафрилла®) в непрерывном режиме не менее 6 мес (в среднем 8,5 мес). До начала терапии и через 6 мес оценивали: размеры очагов эндометриоза (глубокого эндометриоза и эндометриом) с помощью МРТ; интенсивность БС; качество жизни (по опроснику SF-12); уровни антимюллерова гормона (АМГ), эстрадиола и СА-125 в сыворотке крови. Статистический анализ выполняли с использованием парного критерия Уилкоксона.
Результаты. На фоне терапии ДНГ зафиксировано уменьшение объема очагов глубокого эндометриоза в 4 раза и эндометриоидных кист в 5 раз. Отмечено снижение интенсивности БС: балл дисменореи снизился с 6,0 до 0 (p<0,0001), индекс тазовой боли – с 2,0 до 0,2 (p<0,0001). У 93,2% пациенток тазовая боль была купирована. Уровень антимюллерова гормона и эстрадиола статистически не изменился, СА-125 снизился в 2 раза. Основным побочным эффектом были ациклические кровянистые выделения (33,9%), не приведшие в большинстве случаев к отмене терапии.
Заключение. Терапия ДНГ в непрерывном режиме продемонстрировала высокую эффективность в регрессе эндометриоидных очагов и улучшении качества жизни пациенток с эндометриозом. Важным клиническим преимуществом является сохранение овариального резерва на фоне лечения. Таким образом, прием ДНГ (Зафрилла®) можно рассматривать как эффективный и безопасный вариант консервативной терапии эндометриоза в перспективе для длительного использования.
Ключевые слова: эндометриоз, глубокий эндометриоз, эндометриоидные кисты яичников, дисменорея, диеногест, магнитно-резонансная томография, переносимость терапии, качество жизни, измерение выраженности боли, овариальный резерв
Aim. To assess the dynamics of endometriotic lesions, pain intensity, and ovarian reserve parameters in patients with endometriosis receiving DNG therapy.
Materials and methods. A prospective study was conducted involving 71 women with MRI-confirmed endometriosis (mean age 32.1 years) who were not indicated for surgical treatment. Patients received DNG 2 mg/day (Zafrilla®) continuously for at least 6 months (mean 8.5 months). Assessments performed before treatment initiation and after 6 months included: size of endometriotic lesions (deep endometriosis and endometriomas) using MRI; pain intensity; quality of life (SF-12 questionnaire); and serum levels of anti-Müllerian hormone (AMH), estradiol, and CA-125. Statistical analysis was performed using the Wilcoxon signed-rank test.
Results. DNG therapy resulted in a significant reduction in the volume of deep endometriosis foci by 4 times and endometriotic cysts by 5 times. A decrease in pain intensity was observed: the dysmenorrhea score decreased from 6.0 to 0 (p<0.0001), and the pelvic pain index decreased from 2.0 to 0.2 (p<0.0001). Pelvic pain was resolved in 93.2% of patients. AMH and estradiol levels showed no statistically significant change, while CA-125 levels decreased by half. The main adverse effect was acyclic bleeding (33.9%), which did not lead to therapy discontinuation in most cases.
Conclusion. Continuous DNG therapy demonstrated high efficacy in the regression of endometriotic lesions and improvement in the quality of life of patients with endometriosis. An important clinical advantage is the preservation of ovarian reserve during treatment. Thus, dienogest (Zafrilla®) can be considered an effective and safe option for the long-term conservative management of endometriosis.
Keywords: endometriosis, deep endometriosis, endometrioid ovarian cysts, dysmenorrhea, dienogest, magnetic resonance imaging, treatment tolerability, quality of life, pain measurement, ovarian reserve
Цель. Оценить динамику эндометриоидных очагов, интенсивности БС и показателей овариального резерва у пациенток с эндометриозом на фоне терапии ДНГ.
Материалы и методы. Проведено проспективное исследование, включающее 71 женщину с эндометриозом (средний возраст – 32,1 года), подтвержденным на основании данных МРТ органов малого таза, которым не показано хирургическое лечение. Пациентки получали ДНГ 2 мг в сутки (Зафрилла®) в непрерывном режиме не менее 6 мес (в среднем 8,5 мес). До начала терапии и через 6 мес оценивали: размеры очагов эндометриоза (глубокого эндометриоза и эндометриом) с помощью МРТ; интенсивность БС; качество жизни (по опроснику SF-12); уровни антимюллерова гормона (АМГ), эстрадиола и СА-125 в сыворотке крови. Статистический анализ выполняли с использованием парного критерия Уилкоксона.
Результаты. На фоне терапии ДНГ зафиксировано уменьшение объема очагов глубокого эндометриоза в 4 раза и эндометриоидных кист в 5 раз. Отмечено снижение интенсивности БС: балл дисменореи снизился с 6,0 до 0 (p<0,0001), индекс тазовой боли – с 2,0 до 0,2 (p<0,0001). У 93,2% пациенток тазовая боль была купирована. Уровень антимюллерова гормона и эстрадиола статистически не изменился, СА-125 снизился в 2 раза. Основным побочным эффектом были ациклические кровянистые выделения (33,9%), не приведшие в большинстве случаев к отмене терапии.
Заключение. Терапия ДНГ в непрерывном режиме продемонстрировала высокую эффективность в регрессе эндометриоидных очагов и улучшении качества жизни пациенток с эндометриозом. Важным клиническим преимуществом является сохранение овариального резерва на фоне лечения. Таким образом, прием ДНГ (Зафрилла®) можно рассматривать как эффективный и безопасный вариант консервативной терапии эндометриоза в перспективе для длительного использования.
Ключевые слова: эндометриоз, глубокий эндометриоз, эндометриоидные кисты яичников, дисменорея, диеногест, магнитно-резонансная томография, переносимость терапии, качество жизни, измерение выраженности боли, овариальный резерв
________________________________________________
Aim. To assess the dynamics of endometriotic lesions, pain intensity, and ovarian reserve parameters in patients with endometriosis receiving DNG therapy.
Materials and methods. A prospective study was conducted involving 71 women with MRI-confirmed endometriosis (mean age 32.1 years) who were not indicated for surgical treatment. Patients received DNG 2 mg/day (Zafrilla®) continuously for at least 6 months (mean 8.5 months). Assessments performed before treatment initiation and after 6 months included: size of endometriotic lesions (deep endometriosis and endometriomas) using MRI; pain intensity; quality of life (SF-12 questionnaire); and serum levels of anti-Müllerian hormone (AMH), estradiol, and CA-125. Statistical analysis was performed using the Wilcoxon signed-rank test.
Results. DNG therapy resulted in a significant reduction in the volume of deep endometriosis foci by 4 times and endometriotic cysts by 5 times. A decrease in pain intensity was observed: the dysmenorrhea score decreased from 6.0 to 0 (p<0.0001), and the pelvic pain index decreased from 2.0 to 0.2 (p<0.0001). Pelvic pain was resolved in 93.2% of patients. AMH and estradiol levels showed no statistically significant change, while CA-125 levels decreased by half. The main adverse effect was acyclic bleeding (33.9%), which did not lead to therapy discontinuation in most cases.
Conclusion. Continuous DNG therapy demonstrated high efficacy in the regression of endometriotic lesions and improvement in the quality of life of patients with endometriosis. An important clinical advantage is the preservation of ovarian reserve during treatment. Thus, dienogest (Zafrilla®) can be considered an effective and safe option for the long-term conservative management of endometriosis.
Keywords: endometriosis, deep endometriosis, endometrioid ovarian cysts, dysmenorrhea, dienogest, magnetic resonance imaging, treatment tolerability, quality of life, pain measurement, ovarian reserve
Полный текст
Список литературы
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8. Shimizu Y, Takeuchi T, Mita S, et al. Dienogest, a synthetic progestin, inhibits the proliferation of immortalized human endometrial epithelial cells with suppression of cyclin D1 gene expression. Mol Hum Reprod. 2009;15(10):693-701. DOI:10.1093/molehr/gap042
9. Heinemann K, Imthurn B, Marions L, et al. Safety of Dienogest and Other Hormonal Treatments for Endometriosis in Real-World Clinical Practice (VIPOS): A Large Noninterventional Study. Adv Ther. 2020;37(5):2528-37. DOI:10.1007/s12325-020-01331-z
10. Maiorana A, Maranto M, Restivo V, et al. Evaluation of long-term efficacy and safety of dienogest in patients with chronic cyclic pelvic pain associated with endometriosis. Arch Gynecol Obstet. 2024;309(2):589-97. DOI:10.1007/s00404-023-07271-7
11. Vallée A, Saridogan E, Petraglia F, et al. Horizons in Endometriosis: Proceedings of the Montreux Reproductive Summit, 14-15 July 2023. Facts Views Vis Obgyn. 2024;16(Suppl. 1):1-32. DOI:10.52054/FVVO.16.s1.011
12. Pinto da Costa Viana D, Jacobsen L, Padovesi I, et al. Tolerability and Shared Decision-Making in the Hormonal Management of Endometriosis-Associated Pain. Biomedicines. 2025;13(9). DOI:10.3390/biomedicines13092294
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15. Чернуха Г.Е., Солопова А.Е., Пронина В.А. Новые возможности оценки магнитно-резонансных характеристик эндометриоидных кист яичников и их реакция на терапию диеногестом. Акушерство и гинекология. 2024;6:114-22 [Chernukha GE, Solopova AE, Pronina VA. New possibilities for assessing the magnetic resonance characteristics of endometrioid ovarian cysts and their response to dienogest therapy. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024;(6):114-22 (in Russian)]. DOI:10.18565/aig.2024.56
16. Berlanda N, Somigliana E, Frattaruolo MP, et al. Surgery versus hormonal therapy for deep endometriosis: is it a choice of the physician? Eur J Obstet Gynecol Reprod Biol. 2017;209:67-71. DOI:10.1016/j.ejogrb.2016.07.513
17. Wu H, Liu JJ, Ye ST, et al. Efficacy and safety of dienogest in the treatment of deep infiltrating endometriosis: A meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2024;297:40-9. DOI:10.1016/j.ejogrb.2024.03.032
18. Vercellini P, Sergenti G, Buggio L, et al. Advances in the medical management of bowel endometriosis. Best Pract Res Clin Obstet Gynaecol. 2021;71:78-99. DOI:10.1016/j.bpobgyn.2020.06.004
19. Ceccaroni M, Baggio S, Capezzuoli T, et al. Conservative Management of Bowel Endometriosis: Cross-Sectional Analysis for Assessing Clinical Outcomes and Quality-of-Life. J Clin Med. 2024;13(21):6574. DOI:10.3390/jcm13216574
20. Contreras CA, Brunel I, Restrepo M, et al. The Effect of Dienogest on Deep Endometriosis Nodules Involving the Recto-Sigmoid Colon: A Prospective Longitudinal Long-Term Study. J Clin Med. 2025;14(14):5164. DOI:10.3390/jcm14145164
21. Irahara M, Harada T, Momoeda M, Tamaki Y. Hormonal and histological study on irregular genital bleeding in patients with endometriosis during treatment with dienogest, a novel progestational therapeutic agent. Reprod Med Biol. 2007;6(4):223-8. DOI:10.1111/j.1447-0578.2007.00189.x
22. Muraoka A, Osuka S, Yabuki A, et al. Impact of perioperative use of GnRH agonist or dienogest on ovarian reserve after cystectomy for endometriomas: a randomized controlled trial. Reprod Biol Endocrinol. 2021;19(1):179. DOI:10.1186/s12958-021-00866-2
23. Karataş E, Temiz BE, Mümüşoğlu S, et al. The effect of dienogest treatment on anti-Mullerian hormone in patients with endometrioma: a 12-month follow-up study. J Turk Ger Gynecol Assoc. 2024;25(2):102-6. DOI:10.4274/jtgga.galenos.2024.2022-9-4
24. Benaglia L, Somigliana E, Vercellini P, et al. Endometriotic ovarian cysts negatively affect the rate of spontaneous ovulation. Hum Reprod. 2009;24(9):2183-6. DOI:10.1093/humrep/dep202
25. Muzii L, Galati G, Di Tucci C, et al. Medical treatment of ovarian endometriomas: a prospective evaluation of the effect of dienogest on ovarian reserve, cyst diameter, and associated pain. Gynecol Endocrinol. 2020;36(1):81-3. DOI:10.1080/09513590.2019.1640199
2. Chapron C, Marcellin L, Borghese B, Santulli P. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol. 2019;15(11):666-82. DOI:10.1038/s41574-019-0245-z
3. NICE guideline. Endometriosis: diagnosis and management. The Royal College of Obstetricians and Gynaecologists. 2017. Available at: https://www.nice.org.uk/guidance/ng73. Accessed: 15.12.2025.
4. Ceccaroni M, Bounous VE, Clarizia R, et al. Recurrent endometriosis: a battle against an unknown enemy. Eur J Contracept Reprod Health Care. 2019;24(6):464-74. DOI:10.1080/13625187.2019.1662391
5. Endometrioz. Klinicheskie rekomendatsii Minzdrava Rossii. 2024. Available at: https://cr.minzdrav.gov.ru/preview-cr/259_2. Accessed: 15.12.2025 (in Russian).
6. Grandi G, Mueller M, Bersinger NA, et al. Does dienogest influence the inflammatory response of endometriotic cells? A systematic review. Inflamm Res. 2016;65(3):183-92. DOI:10.1007/s00011-015-0909-7
7. Miyashita M, Koga K, Takamura M, et al. Dienogest reduces proliferation, aromatase expression and angiogenesis, and increases apoptosis in human endometriosis. Gynecol Endocrinol. 2014;30(9):644-8. DOI:10.3109/09513590.2014.911279
8. Shimizu Y, Takeuchi T, Mita S, et al. Dienogest, a synthetic progestin, inhibits the proliferation of immortalized human endometrial epithelial cells with suppression of cyclin D1 gene expression. Mol Hum Reprod. 2009;15(10):693-701. DOI:10.1093/molehr/gap042
9. Heinemann K, Imthurn B, Marions L, et al. Safety of Dienogest and Other Hormonal Treatments for Endometriosis in Real-World Clinical Practice (VIPOS): A Large Noninterventional Study. Adv Ther. 2020;37(5):2528-37. DOI:10.1007/s12325-020-01331-z
10. Maiorana A, Maranto M, Restivo V, et al. Evaluation of long-term efficacy and safety of dienogest in patients with chronic cyclic pelvic pain associated with endometriosis. Arch Gynecol Obstet. 2024;309(2):589-97. DOI:10.1007/s00404-023-07271-7
11. Vallée A, Saridogan E, Petraglia F, et al. Horizons in Endometriosis: Proceedings of the Montreux Reproductive Summit, 14-15 July 2023. Facts Views Vis Obgyn. 2024;16(Suppl. 1):1-32. DOI:10.52054/FVVO.16.s1.011
12. Pinto da Costa Viana D, Jacobsen L, Padovesi I, et al. Tolerability and Shared Decision-Making in the Hormonal Management of Endometriosis-Associated Pain. Biomedicines. 2025;13(9). DOI:10.3390/biomedicines13092294
13. Piriyev E, Schiermeier S, Römer T. Hormonal Treatment of Endometriosis: A Narrative Review. Pharmaceuticals (Basel). 2025;18(4):588. DOI:10.3390/ph18040588
14. La Torre F, Vannuccini S, Toscano F, et al. Long-term treatment for endometriosis with dienogest: efficacy, side effects and tolerability. Gynecol Endocrinol. 2024;40(1):2336121. DOI:10.1080/09513590.2024.2336121
15. Chernukha GE, Solopova AE, Pronina VA. New possibilities for assessing the magnetic resonance characteristics of endometrioid ovarian cysts and their response to dienogest therapy. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024;(6):114-22 (in Russian). DOI:10.18565/aig.2024.56
16. Berlanda N, Somigliana E, Frattaruolo MP, et al. Surgery versus hormonal therapy for deep endometriosis: is it a choice of the physician? Eur J Obstet Gynecol Reprod Biol. 2017;209:67-71. DOI:10.1016/j.ejogrb.2016.07.513
17. Wu H, Liu JJ, Ye ST, et al. Efficacy and safety of dienogest in the treatment of deep infiltrating endometriosis: A meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2024;297:40-9. DOI:10.1016/j.ejogrb.2024.03.032
18. Vercellini P, Sergenti G, Buggio L, et al. Advances in the medical management of bowel endometriosis. Best Pract Res Clin Obstet Gynaecol. 2021;71:78-99. DOI:10.1016/j.bpobgyn.2020.06.004
19. Ceccaroni M, Baggio S, Capezzuoli T, et al. Conservative Management of Bowel Endometriosis: Cross-Sectional Analysis for Assessing Clinical Outcomes and Quality-of-Life. J Clin Med. 2024;13(21):6574. DOI:10.3390/jcm13216574
20. Contreras CA, Brunel I, Restrepo M, et al. The Effect of Dienogest on Deep Endometriosis Nodules Involving the Recto-Sigmoid Colon: A Prospective Longitudinal Long-Term Study. J Clin Med. 2025;14(14):5164. DOI:10.3390/jcm14145164
21. Irahara M, Harada T, Momoeda M, Tamaki Y. Hormonal and histological study on irregular genital bleeding in patients with endometriosis during treatment with dienogest, a novel progestational therapeutic agent. Reprod Med Biol. 2007;6(4):223-8. DOI:10.1111/j.1447-0578.2007.00189.x
22. Muraoka A, Osuka S, Yabuki A, et al. Impact of perioperative use of GnRH agonist or dienogest on ovarian reserve after cystectomy for endometriomas: a randomized controlled trial. Reprod Biol Endocrinol. 2021;19(1):179. DOI:10.1186/s12958-021-00866-2
23. Karataş E, Temiz BE, Mümüşoğlu S, et al. The effect of dienogest treatment on anti-Mullerian hormone in patients with endometrioma: a 12-month follow-up study. J Turk Ger Gynecol Assoc. 2024;25(2):102-6. DOI:10.4274/jtgga.galenos.2024.2022-9-4
24. Benaglia L, Somigliana E, Vercellini P, et al. Endometriotic ovarian cysts negatively affect the rate of spontaneous ovulation. Hum Reprod. 2009;24(9):2183-6. DOI:10.1093/humrep/dep202
25. Muzii L, Galati G, Di Tucci C, et al. Medical treatment of ovarian endometriomas: a prospective evaluation of the effect of dienogest on ovarian reserve, cyst diameter, and associated pain. Gynecol Endocrinol. 2020;36(1):81-3. DOI:10.1080/09513590.2019.1640199
2. Chapron C, Marcellin L, Borghese B, Santulli P. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol. 2019;15(11):666-82. DOI:10.1038/s41574-019-0245-z
3. NICE guideline. Endometriosis: diagnosis and management. The Royal College of Obstetricians and Gynaecologists. 2017. Available at: https://www.nice.org.uk/guidance/ng73. Accessed: 15.12.2025.
4. Ceccaroni M, Bounous VE, Clarizia R, et al. Recurrent endometriosis: a battle against an unknown enemy. Eur J Contracept Reprod Health Care. 2019;24(6):464-74. DOI:10.1080/13625187.2019.1662391
5. Эндометриоз. Клинические рекомендации Минздрава России. 2024. Режим доступа: https://cr.minzdrav.gov.ru/preview-cr/259_2. Ссылка активна на 15.12.2025 [Endometrioz. Klinicheskie rekomendatsii Minzdrava Rossii. 2024. Available at: https://cr.minzdrav.gov.ru/preview-cr/259_2. Accessed: 15.12.2025 (in Russian)].
6. Grandi G, Mueller M, Bersinger NA, et al. Does dienogest influence the inflammatory response of endometriotic cells? A systematic review. Inflamm Res. 2016;65(3):183-92. DOI:10.1007/s00011-015-0909-7
7. Miyashita M, Koga K, Takamura M, et al. Dienogest reduces proliferation, aromatase expression and angiogenesis, and increases apoptosis in human endometriosis. Gynecol Endocrinol. 2014;30(9):644-8. DOI:10.3109/09513590.2014.911279
8. Shimizu Y, Takeuchi T, Mita S, et al. Dienogest, a synthetic progestin, inhibits the proliferation of immortalized human endometrial epithelial cells with suppression of cyclin D1 gene expression. Mol Hum Reprod. 2009;15(10):693-701. DOI:10.1093/molehr/gap042
9. Heinemann K, Imthurn B, Marions L, et al. Safety of Dienogest and Other Hormonal Treatments for Endometriosis in Real-World Clinical Practice (VIPOS): A Large Noninterventional Study. Adv Ther. 2020;37(5):2528-37. DOI:10.1007/s12325-020-01331-z
10. Maiorana A, Maranto M, Restivo V, et al. Evaluation of long-term efficacy and safety of dienogest in patients with chronic cyclic pelvic pain associated with endometriosis. Arch Gynecol Obstet. 2024;309(2):589-97. DOI:10.1007/s00404-023-07271-7
11. Vallée A, Saridogan E, Petraglia F, et al. Horizons in Endometriosis: Proceedings of the Montreux Reproductive Summit, 14-15 July 2023. Facts Views Vis Obgyn. 2024;16(Suppl. 1):1-32. DOI:10.52054/FVVO.16.s1.011
12. Pinto da Costa Viana D, Jacobsen L, Padovesi I, et al. Tolerability and Shared Decision-Making in the Hormonal Management of Endometriosis-Associated Pain. Biomedicines. 2025;13(9). DOI:10.3390/biomedicines13092294
13. Piriyev E, Schiermeier S, Römer T. Hormonal Treatment of Endometriosis: A Narrative Review. Pharmaceuticals (Basel). 2025;18(4):588. DOI:10.3390/ph18040588
14. La Torre F, Vannuccini S, Toscano F, et al. Long-term treatment for endometriosis with dienogest: efficacy, side effects and tolerability. Gynecol Endocrinol. 2024;40(1):2336121. DOI:10.1080/09513590.2024.2336121
15. Чернуха Г.Е., Солопова А.Е., Пронина В.А. Новые возможности оценки магнитно-резонансных характеристик эндометриоидных кист яичников и их реакция на терапию диеногестом. Акушерство и гинекология. 2024;6:114-22 [Chernukha GE, Solopova AE, Pronina VA. New possibilities for assessing the magnetic resonance characteristics of endometrioid ovarian cysts and their response to dienogest therapy. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024;(6):114-22 (in Russian)]. DOI:10.18565/aig.2024.56
16. Berlanda N, Somigliana E, Frattaruolo MP, et al. Surgery versus hormonal therapy for deep endometriosis: is it a choice of the physician? Eur J Obstet Gynecol Reprod Biol. 2017;209:67-71. DOI:10.1016/j.ejogrb.2016.07.513
17. Wu H, Liu JJ, Ye ST, et al. Efficacy and safety of dienogest in the treatment of deep infiltrating endometriosis: A meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2024;297:40-9. DOI:10.1016/j.ejogrb.2024.03.032
18. Vercellini P, Sergenti G, Buggio L, et al. Advances in the medical management of bowel endometriosis. Best Pract Res Clin Obstet Gynaecol. 2021;71:78-99. DOI:10.1016/j.bpobgyn.2020.06.004
19. Ceccaroni M, Baggio S, Capezzuoli T, et al. Conservative Management of Bowel Endometriosis: Cross-Sectional Analysis for Assessing Clinical Outcomes and Quality-of-Life. J Clin Med. 2024;13(21):6574. DOI:10.3390/jcm13216574
20. Contreras CA, Brunel I, Restrepo M, et al. The Effect of Dienogest on Deep Endometriosis Nodules Involving the Recto-Sigmoid Colon: A Prospective Longitudinal Long-Term Study. J Clin Med. 2025;14(14):5164. DOI:10.3390/jcm14145164
21. Irahara M, Harada T, Momoeda M, Tamaki Y. Hormonal and histological study on irregular genital bleeding in patients with endometriosis during treatment with dienogest, a novel progestational therapeutic agent. Reprod Med Biol. 2007;6(4):223-8. DOI:10.1111/j.1447-0578.2007.00189.x
22. Muraoka A, Osuka S, Yabuki A, et al. Impact of perioperative use of GnRH agonist or dienogest on ovarian reserve after cystectomy for endometriomas: a randomized controlled trial. Reprod Biol Endocrinol. 2021;19(1):179. DOI:10.1186/s12958-021-00866-2
23. Karataş E, Temiz BE, Mümüşoğlu S, et al. The effect of dienogest treatment on anti-Mullerian hormone in patients with endometrioma: a 12-month follow-up study. J Turk Ger Gynecol Assoc. 2024;25(2):102-6. DOI:10.4274/jtgga.galenos.2024.2022-9-4
24. Benaglia L, Somigliana E, Vercellini P, et al. Endometriotic ovarian cysts negatively affect the rate of spontaneous ovulation. Hum Reprod. 2009;24(9):2183-6. DOI:10.1093/humrep/dep202
25. Muzii L, Galati G, Di Tucci C, et al. Medical treatment of ovarian endometriomas: a prospective evaluation of the effect of dienogest on ovarian reserve, cyst diameter, and associated pain. Gynecol Endocrinol. 2020;36(1):81-3. DOI:10.1080/09513590.2019.1640199
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2. Chapron C, Marcellin L, Borghese B, Santulli P. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol. 2019;15(11):666-82. DOI:10.1038/s41574-019-0245-z
3. NICE guideline. Endometriosis: diagnosis and management. The Royal College of Obstetricians and Gynaecologists. 2017. Available at: https://www.nice.org.uk/guidance/ng73. Accessed: 15.12.2025.
4. Ceccaroni M, Bounous VE, Clarizia R, et al. Recurrent endometriosis: a battle against an unknown enemy. Eur J Contracept Reprod Health Care. 2019;24(6):464-74. DOI:10.1080/13625187.2019.1662391
5. Endometrioz. Klinicheskie rekomendatsii Minzdrava Rossii. 2024. Available at: https://cr.minzdrav.gov.ru/preview-cr/259_2. Accessed: 15.12.2025 (in Russian).
6. Grandi G, Mueller M, Bersinger NA, et al. Does dienogest influence the inflammatory response of endometriotic cells? A systematic review. Inflamm Res. 2016;65(3):183-92. DOI:10.1007/s00011-015-0909-7
7. Miyashita M, Koga K, Takamura M, et al. Dienogest reduces proliferation, aromatase expression and angiogenesis, and increases apoptosis in human endometriosis. Gynecol Endocrinol. 2014;30(9):644-8. DOI:10.3109/09513590.2014.911279
8. Shimizu Y, Takeuchi T, Mita S, et al. Dienogest, a synthetic progestin, inhibits the proliferation of immortalized human endometrial epithelial cells with suppression of cyclin D1 gene expression. Mol Hum Reprod. 2009;15(10):693-701. DOI:10.1093/molehr/gap042
9. Heinemann K, Imthurn B, Marions L, et al. Safety of Dienogest and Other Hormonal Treatments for Endometriosis in Real-World Clinical Practice (VIPOS): A Large Noninterventional Study. Adv Ther. 2020;37(5):2528-37. DOI:10.1007/s12325-020-01331-z
10. Maiorana A, Maranto M, Restivo V, et al. Evaluation of long-term efficacy and safety of dienogest in patients with chronic cyclic pelvic pain associated with endometriosis. Arch Gynecol Obstet. 2024;309(2):589-97. DOI:10.1007/s00404-023-07271-7
11. Vallée A, Saridogan E, Petraglia F, et al. Horizons in Endometriosis: Proceedings of the Montreux Reproductive Summit, 14-15 July 2023. Facts Views Vis Obgyn. 2024;16(Suppl. 1):1-32. DOI:10.52054/FVVO.16.s1.011
12. Pinto da Costa Viana D, Jacobsen L, Padovesi I, et al. Tolerability and Shared Decision-Making in the Hormonal Management of Endometriosis-Associated Pain. Biomedicines. 2025;13(9). DOI:10.3390/biomedicines13092294
13. Piriyev E, Schiermeier S, Römer T. Hormonal Treatment of Endometriosis: A Narrative Review. Pharmaceuticals (Basel). 2025;18(4):588. DOI:10.3390/ph18040588
14. La Torre F, Vannuccini S, Toscano F, et al. Long-term treatment for endometriosis with dienogest: efficacy, side effects and tolerability. Gynecol Endocrinol. 2024;40(1):2336121. DOI:10.1080/09513590.2024.2336121
15. Chernukha GE, Solopova AE, Pronina VA. New possibilities for assessing the magnetic resonance characteristics of endometrioid ovarian cysts and their response to dienogest therapy. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024;(6):114-22 (in Russian). DOI:10.18565/aig.2024.56
16. Berlanda N, Somigliana E, Frattaruolo MP, et al. Surgery versus hormonal therapy for deep endometriosis: is it a choice of the physician? Eur J Obstet Gynecol Reprod Biol. 2017;209:67-71. DOI:10.1016/j.ejogrb.2016.07.513
17. Wu H, Liu JJ, Ye ST, et al. Efficacy and safety of dienogest in the treatment of deep infiltrating endometriosis: A meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2024;297:40-9. DOI:10.1016/j.ejogrb.2024.03.032
18. Vercellini P, Sergenti G, Buggio L, et al. Advances in the medical management of bowel endometriosis. Best Pract Res Clin Obstet Gynaecol. 2021;71:78-99. DOI:10.1016/j.bpobgyn.2020.06.004
19. Ceccaroni M, Baggio S, Capezzuoli T, et al. Conservative Management of Bowel Endometriosis: Cross-Sectional Analysis for Assessing Clinical Outcomes and Quality-of-Life. J Clin Med. 2024;13(21):6574. DOI:10.3390/jcm13216574
20. Contreras CA, Brunel I, Restrepo M, et al. The Effect of Dienogest on Deep Endometriosis Nodules Involving the Recto-Sigmoid Colon: A Prospective Longitudinal Long-Term Study. J Clin Med. 2025;14(14):5164. DOI:10.3390/jcm14145164
21. Irahara M, Harada T, Momoeda M, Tamaki Y. Hormonal and histological study on irregular genital bleeding in patients with endometriosis during treatment with dienogest, a novel progestational therapeutic agent. Reprod Med Biol. 2007;6(4):223-8. DOI:10.1111/j.1447-0578.2007.00189.x
22. Muraoka A, Osuka S, Yabuki A, et al. Impact of perioperative use of GnRH agonist or dienogest on ovarian reserve after cystectomy for endometriomas: a randomized controlled trial. Reprod Biol Endocrinol. 2021;19(1):179. DOI:10.1186/s12958-021-00866-2
23. Karataş E, Temiz BE, Mümüşoğlu S, et al. The effect of dienogest treatment on anti-Mullerian hormone in patients with endometrioma: a 12-month follow-up study. J Turk Ger Gynecol Assoc. 2024;25(2):102-6. DOI:10.4274/jtgga.galenos.2024.2022-9-4
24. Benaglia L, Somigliana E, Vercellini P, et al. Endometriotic ovarian cysts negatively affect the rate of spontaneous ovulation. Hum Reprod. 2009;24(9):2183-6. DOI:10.1093/humrep/dep202
25. Muzii L, Galati G, Di Tucci C, et al. Medical treatment of ovarian endometriomas: a prospective evaluation of the effect of dienogest on ovarian reserve, cyst diameter, and associated pain. Gynecol Endocrinol. 2020;36(1):81-3. DOI:10.1080/09513590.2019.1640199
Авторы
Г.Е. Чернуха, В.А. Пронина*, А.Е. Солопова
ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В.И. Кулакова» Минздрава России, Москва, Российская Федерация
*ver22595@yandex.ru
Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russian Federation
*ver22595@yandex.ru
ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В.И. Кулакова» Минздрава России, Москва, Российская Федерация
*ver22595@yandex.ru
________________________________________________
Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russian Federation
*ver22595@yandex.ru
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