dienogest

Research aim: to determine the clinical efficacy and safety of bioavailable curcumin Longimin® in the complex anti-relapse therapy of patients with extragenital endometriosis after surgery.
Materials and methods. Study involved 45 women with a mean age of 29.3 ± 3.6 years with a diagnosis of extragenital endometriosis. After surgical treatment of this disease all patients were prescribed dienogest 2 mg/day for 6 months with anti-relapse purpose. After that, 22 patients did not receive drug treatment (group 1) and other 23 women started a six-month course of 400 mg bioavailable curcumin (group 2).
Results. After 12 months of observation 3 cases (13.6%) of newly formed foci of endometriosis were found among patients of group 1, two of which were multi-endometriomas, and the third was retrocervical heterotopia. There were no signs of recurrence in the group of sequential use of dienogest and bioavailable curcumin. In addition, 6 months after completion of hormonal treatment the number of women with chronic pelvic pain in group 1 was increased and average score on a visual analogue scale (VAS) was increased by 80% (p ≤0.05). It was accompanied by a stable moderately high level of anxiety throughout the observation period. At the same time the number of women who complained of intermenstrual pain in group 2 decreased from 15 to 13, and the average VAS score decreased by 13% (p ≥0.05) during the treatment period. Patients in group 2 noted an improvement in emotional control during treatment, which resulted in the average score decrease on the scale of personal and situational anxiety of the Spielberg-Hanin's questionnaire (25% and 30% respectively, p ≤0.05).
Conclusions. The nature of the endometriosis development and progression is multipathogenetic. Blocking only its hormonal link, especially in cases of extragenital forms, may not be sufficient to stop the pathological process and prevent recurrence
in the long term. Оbtained results of sequential course of dienogest and bioavailable curcumin Longimin® with anti-relapse purpose showed the wider clinical effectiveness of this therapy, which is probably based on additional inhibition of systemic inflammation, proliferation, stroma and psychogenic component of disease.

Endometriosis is a chronic disease that requires long-term treatment, the goal of which is effectively use drugs and avoids repeated surgical interventions.
The quality of patients’ life depends on the varying degrees of symptoms such as pelvic pain, dyspareunia, dysmenorrhea. Endometriosis causes infertility and perinatal complications. The symptoms of endometriosis often affect psychological and social well-being, and threaten the relationships, sexuality and mental health of women. Women with endometriosis have high levels of anxiety, depression, and other psychiatric disorders that can aggravate the severity of their pain.
The existing statistics on the endometriosis incidence is underestimated given the diagnostic difficulties. So far, there are no final, only generally an accepted method of treating endometriosis, and in most cases, treatment is only eliminates the symptoms. Today, it is desirable to take a conservative approach to treatment, avoiding surgery, and hormone therapy is recommended to relieve pain associated with endometriosis. An individual approach is important in the management of patients with endometriosis, taking into account the reproductive plans and needs of woman. Medical treatment methods should be used as much as possible, for example, dienogest 2 mg (in particular, Savis drug). Dienogest is a derivative of 19-nortestosterone, which has an antiproliferative effect on the endometriosis foci.
Savis is a drug specially formulated for the endometriosis treatment. Savis may be prescribed to relieve symptoms before and after surgery to prevent relapse. The safety profile of dienogest has been studied and data is constantly accumulating, given the popularity of its prescription.
The effectiveness of dienogest should be assessed primarily by its effect on pain and quality of life, on maintaining fertility, and on the possibility of avoiding or postponing surgery. This is important for various forms of endometriosis: endometriomas, extragenital endometriosis, adenomyosis.

The article describes the clinical case of the nodular form of adenomyosis, first detected in a patient at the age of 16 years after another appeal to a gynecologist in connection with pronounced prolonged dysmenorrhea with ultrasound of a small pelvis. After the diagnosis of “Nodular form of adenomyosis”, the patient received 6 injections of triptorelin acetate 3.62 mg, resulting in an adenomyosis node decreased in size from 72 x 68 mm to 31 x 29 mm. Taking into account the developed side effects (aches in bones, hot flushes, weakness, tachycardia), therapy with triptorelin was discontinued. Clinical efficacy persisted for 6 months, after which painful menstruation resumed.

Two years later, the patient was urgently transferred to the gynecological department of the Kyiv City Clinical Hospital No. 9 with severe manifestations of dysmenorrhea. With ultrasound of the pelvic organs, an endometrioid node in the uterus measuring 50 x 46 mm was found. The patient was recommended receiving Visanne (dienogest) in a dose of 2 mg, which she took 1 year and 10 months, being under constant supervision of the clinic’s specialists. The unauthorized break in treatment, which the patient explained with good health, provoked the resumption of painful symptoms. Visanne was continued for 2 years, as a result of which the endometrioid node decreased to 21.0 x 16.7 mm.

In April 2017, in connection with the patient’s marriage and the desire to become pregnant, the reception of the dienogest was canceled. It is proposed to take a plant complex of antiproliferative action containing indole-3-carbinol 200 mg and green tea extract 82 mg. After 8 months, the patient was diagnosed with a pregnancy at 4 weeks, against which the adenomyosis node decreased to 18.1 x 11.1 mm. The results of the first two ultrasound screenings of the fetus in the gestation period of 13 and 18 weeks are described. There were no deviations in fetal development, and the endometriosis focus in the uterus was not clearly visualized at the first screening.

The importance of the problem of secondary dysmenorrhea on the background of endometriosis, the establishment of a timely diagnosis and the choice of the right treatment tactics on which the future reproductive health of a teenage girl directly depends.