Post-Operative Dienogest Following Conservative Endometriosis Surgery: A Systematic Review and Meta-Analysis

Study Objective To determine the impact of postoperative hormonal suppression with dienogest on recurrence of endometriosis following conservative endometriosis surgery. Design We performed a meta-analysis and systematic review of observational (retrospective and prospective) studies and randomized controlled trials. Setting The following databases were search from inception to March 2019: Ovid MEDLINE, Ovid EMBASE, PubMed (Non-Medline records only), EBM Reviews - Cochrane Central Register of Controlled Trials, Web of Science, LILACS, clinicaltrials.gov and International Standard Randomised Controlled Trial Number Registry. Patients or Participants We included studies of pre-menopausal women undergoing conservative surgery for endometriosis followed by post-operative dienogest suppression for at least 6 months. Interventions Post-operative suppression with dienogest for at least 6 months duration. Measurements and Main Results Primary outcome was the rate of endometriosis/endometrioma recurrence on imaging. For studies with a comparator group, we compared post-operative suppression with dienogest to no treatment. We screened 361 studies and 11 met inclusion criteria (10 retrospective and 1 prospective cohort studies). These studies included 2243 patients (1314 treated with dienogest and 929 controls). Treatment duration ranged from 6 months to 79 months post-operatively. The mean follow-up period ranged from 6 months for 1 study to 60 months for another, with the remaining 9 studies reporting follow-up periods ranging from 12 months to 43 months. For patients treated with dienogest there were 3 recurrences per 100 women (2.92 events/100 women, 95% CI 2.08, 4.10; 11 studies, 1314 patients, I2=21%, fixed effects model). The odds of recurrence were significantly lower in women treated with dienogest compared to no post-operative hormonal suppression (Log odds -2.09, 95%CI -2.59, -1.59, p Conclusion Post-operative hormonal suppression with dienogest following endometriosis surgery is associated with a low overall recurrence rate, and is superior to no post-operative suppression.