The Relationship between Ovarian Endometrioma Ultrasonographic Size and Treatment with Dienogest: A Retrospective Cohort Study

Abstract

Study Objective To examine the change in ultrasonographic size of ovarian endometrioma during treatment with dienogest Design Retrospective single cohort chart review from 2011-2021. Setting Academic university-affiliated hospital ambulatory clinics Patients or Participants Patients from the study authors' practices were included who had ultrasound findings consistent with ovarian endometriomas. Those who were prescribed dienogest with at least one follow-up ultrasound 3 months or more after treatment initiation were included. Patients also had to be non-pregnant, premenopausal and over the age of 18. Patients were excluded if they underwent surgical management between ultrasonographic assessments of their endometrioma. Sample size was calculated to require 21 patients to detect a mean of the differences in endometrioma size of 1cm, with a power of 80% and a 5% level of significance, assuming the standard deviation of 1.5. Interventions Dienogest 2 mg orally daily for at least 3 months. Measurements and Main Results The primary outcome assessed was change in ultrasound measurement of endometrioma maximum diameter over the study period and secondary outcome was change in total volume. Demographic information was tabulated and described in means and measures of variance. The outcomes were assessed with a paired t-test. A sensitivity analysis was performed for those patients with a surgical diagnosis of endometriosis. A total of 53 patients met inclusion criteria. The average age of participants was 37.72 +/- 6.35, and they were followed for an average of 14.19 +/- 14.17 months. The average change in endometrioma greatest maximum diameter was 0.77 +/- 1.59 (p=0.002) and change in volume was 3.84 +/- 59.00 cm3 (p=0.67). Sensitivity analysis demonstrated a decrease in endometrioma maximum diameter and volume but was not significant. Conclusion Dienogest has the potential to reduce the size of ovarian endometrioma. Future prospective studies are warranted to determine if medical treatment can shrink endometriomas which may ultimately prevent the need for surgery and protect fertility. To examine the change in ultrasonographic size of ovarian endometrioma during treatment with dienogest Retrospective single cohort chart review from 2011-2021. Academic university-affiliated hospital ambulatory clinics Patients from the study authors' practices were included who had ultrasound findings consistent with ovarian endometriomas. Those who were prescribed dienogest with at least one follow-up ultrasound 3 months or more after treatment initiation were included. Patients also had to be non-pregnant, premenopausal and over the age of 18. Patients were excluded if they underwent surgical management between ultrasonographic assessments of their endometrioma. Sample size was calculated to require 21 patients to detect a mean of the differences in endometrioma size of 1cm, with a power of 80% and a 5% level of significance, assuming the standard deviation of 1.5. Dienogest 2 mg orally daily for at least 3 months. The primary outcome assessed was change in ultrasound measurement of endometrioma maximum diameter over the study period and secondary outcome was change in total volume. Demographic information was tabulated and described in means and measures of variance. The outcomes were assessed with a paired t-test. A sensitivity analysis was performed for those patients with a surgical diagnosis of endometriosis. A total of 53 patients met inclusion criteria. The average age of participants was 37.72 +/- 6.35, and they were followed for an average of 14.19 +/- 14.17 months. The average change in endometrioma greatest maximum diameter was 0.77 +/- 1.59 (p=0.002) and change in volume was 3.84 +/- 59.00 cm3 (p=0.67). Sensitivity analysis demonstrated a decrease in endometrioma maximum diameter and volume but was not significant. Dienogest has the potential to reduce the size of ovarian endometrioma. Future prospective studies are warranted to determine if medical treatment can shrink endometriomas which may ultimately prevent the need for surgery and protect fertility.