Recurrent Endometrioma; Outcome of Medical Management with Dienogest

Background: Management of recurrent endometrioma should balance between the risk of unexpected hidden malignancy and the damaging effect of second surgery to ovarian tissue. Dienogest is a fourth generation of progestin and has been used in endometriosis with effective and save reports. Patients and methods: Between April 2015 and August 2016, the recruitment was started to include women with symptomatic recurrent endometrioma after surgery, their ages between 18 – 40 years. The adenxial masses had been evaluated by transvaginal ultrasound to prove the diagnosis which required the presence of ground glass echogenicity and one to four compartments and no papillary structures with detectable blood flow, after signing an informed consent, all patients received dienogest tablet 2 mg daily for 52 weeks. Numeric pain scale, and transvaginal ultrasound were used to evaluate all patients on monthly basis in the first three months, then every three months. Results: Twenty patients had been enrolled with minimum follow up after stopping the treatment is six months up to one year. The size of the cysts ranged from 3.2 cm up to 7 cm, with mean size 5.46 cm, after three months of treatment; mean numeric pain score was 2.5 versus 5.1 on presentation (P<0.001), and the mean of largest diameter of the cyst became 3.1 cm versus 5.45 cm on presentation (p<0.001). By the end of the 6th month of treatment, we had residual cysts (1.8cm) in two patients only which remain in their size until the end of treatment. With the end of follow up no report of recurrence of symptoms neither evidence of ultrasound features of recurrence. Conclusion: Dienogest 2mg per day is a well-tolerated therapy for recurrent endometrioma with safe side effect profile. It can make the patient pain free and reduce the size of the cyst within three months.