Title: Outcome of Laproscopic Treatment of Chronic Pelvic Pain with Endometriosis Cases Followed by Post Operative Progestogens
Authors: Prof (Dr) Rabindra Nath Behera, Dr Ramakanta Sahoo
Objective: This is a Prospective randomized analytical study carried out in department of obstetrics and Gynecology, Hi-Tech Medical College & Hospital, Bhubaneswar, in a tertiary care center to compare the efficacy and safety of dienogest (DNG) with depot leuprolide acetate (LA) in patients with chronic pelvic pain following laparoscopic surgery for endometriosis.
Materials & Method: 242 patients with chronic pelvic pain following laparoscopic surgery for endometriosis were chosen. Prospective randomized trial was done in laproscopic treated patient of endometriosis with chronic pelvic pain with Dienogest (2 mg/day, orally) or depot LA (3.75 mg/4 weeks, intramuscularly) for 12 weeks. The study was conducted over 3year period i.e. from 01.04.2016 to 31.03.2019 in Hi-Tech Medical College & Hospital, Bhubaneswar. A visual analogue scale was used to test the intensity of pain before and after the end of treatment.
Results: There was highly significant reduction in pelvic pain, back pain and dyspareunia in both groups with mean of difference in dienogest group (28.7±5.3,19.0±4.3 and 20.0 ± 3.08 mm, respectively) and in LA group (26.2 ± 3.01, 19.5 ± 3.01 and 17.9 ± 2.9 mm, respectively). The most frequent drug-related adverse effects in dienogest group were vaginal bleeding and weight gain (64.5 and 10.8%, respectively) which were significantly higher than LA group (21.5 and 3.3%, respectively). While the most frequent drug-related adverse effects in LA group were hot flushes and vaginal dryness (46.3 and 15.7%, respectively) which were significantly higher than dieno- gest group (15.7 and 3.3%, respectively).
Conclusion: Daily dienogest is as effective as depot LA for relieving endometriosis-associated pelvic pain, low back pain and dyspareunia. In addition, dienogest has accept- able safety, tolerability and lower incidence of hot flushes. Thus, it may offer an effective and well-tolerated treatment in endometriosis
Keywords: Endometriosis, Chronic Pelvicpain, Laproscopy, Leuprolide acetate (LA), Dienogest (DNG).