Efficacy and Tolerability of Short-Term Hormonal Therapy Following Conservative Surgery for Endometriosis

Efficay and Clinical Tolerability of Short-Term Hormonal Treatment for Endometriosis Pain

  • Yuli Trisetiyono Division of Fertility, Endocrinology and Reproduction, Obstetrics and Gynecology Department Diponegoro University, Kariadi Hospital
  • Razmaeda Sarastry Diponegoro University
  • Julian Dewantiningrum Division of Fetomaternal, Obstetrics and Gynecology Department Diponegoro University, Kariadi Hospital
  • Arufiadi Anityo Mochtar Obstetrics and Gynecology Department Diponegoro University, Kariadi Hospital
  • Herman Kristanto Division of Fetomaternal, Obstetrics and Gynecology Department Diponegoro University, Kariadi Hospital
  • Syarief Thaufik Hidayat
DOI: https://doi.org/10.32771/inajog.v13i4.2588

Abstract

Abstract
Objective: To compare the efficacy and tolerability of four short-term hormonal therapies; Dienogest (DNG), Depot Medroxyprogesterone Acetate (DMPA), continuous Combined Oral Contraceptive (COC), and Leuprolide Acetate (LA); administered for 12 weeks after conservative endometriosis surgery.

Methods: This randomized, prospective, open-label study enrolled reproductive-aged women with surgically confirmed endometriosis. Participants were randomly assigned to receive DNG 2 mg daily, DMPA 150 mg intramuscularly every 12 weeks, continuous COC (ethinyl estradiol 0.03 mg and levonogestrel 0.15 mg) daily, or LA 3.75 mg intramuscularly every 4 weeks. Primary outcomes were changes in pain intensity (visual analog scale, VAS), hormonal markers (estradiol, E2), inflammatory markers (TNF-?), and the Menopause Rating Scale (MRS) as an indicator of tolerability. Data were analyzed using ANOVA with a significance level of p < 0.05.

Results: All four regimens resulted in significant reductions in dysmenorrhea, dyspareunia, and chronic pelvic pain after 12 weeks (p < 0.001). E2 and TNF-? levels decreased significantly in all groups, with the greatest decline observed in the LA arm. No significant differences were found among regimens in pain reduction or biomarker changes (p > 0.05). MRS scores increased transiently at week 8, particularly in the LA group, reflecting hypoestrogenic effects, but decreased by week 12 in all groups.

Conclusion: Short-term postoperative hormonal therapy with DNG, DMPA, COC, or LA effectively reduces pain and inflammatory markers following endometriosis surgery. Progestin-based therapies achieve comparable clinical efficacy to GnRH agonists with superior tolerability. Individualized selection based on symptom profile, side effects, and accessibility is recommended in accordance with ESHRE guidelines.

Keywords: endometriosis-associated pain, Menopause Rating Scale, short-term hormonal therapy.

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Published
2025-10-29
Issue
Volume 13. No. 4 October2025
Section
Research Article