Eficacia del dienogest en el tratamiento de la endometriosis frente a los análogos de la GnRH: revisión sistemática

Abstract

Endometriosis is a chronic inflammatory condition that primarily affects women of reproductive age and is associated with symptoms such as chronic pelvic pain, dysmenorrhea, dyspareunia, and infertility. Available treatments include dienogest and gonadotropin-releasing hormone (GnRH) analogs. Both treatment modalities have been shown to be effective in relieving symptoms; however, significant differences have been reported in recurrence rates, quality of life, and adverse effects. Objective: To compare the efficacy of dienogest with that of GnRH analogs in the treatment of endometriosis through a systematic review. Methods: A systematic review will be conducted in accordance with the PRISMA guidelines. Randomized controlled trials and systematic reviews with meta-analyses published between 2020 and 2025 will be included. Searches will be performed in major databases, including PubMed, Scopus, the Cochrane Library, Web of Science, Springer Link, Taylor & Francis, and SciELO. Results: Dienogest and GnRH analogs are similarly effective in managing endometriosis-related pain and recurrence. Dienogest has a more favorable safety profile, with fewer hot flashes and less vaginal dryness, although it is associated with a higher incidence of irregular bleeding and weight gain. GnRH agonists may cause bone loss and should be limited to 6 months when not combined with add-back hormonal therapy. Sequential treatment with GnRH agonists followed by dienogest may improve treatment adherence and reduce adverse effects. Furthermore, dienogest is more cost-effective for postoperative management. Keywords: Endometriosis, dienogest, GnRH analogs, quality of life, recurrence