How effective is Dienogest:-?? dienogest does not work on fibroid
Dienogest gives good results in 50 %
cases of endometriosis. In the other 50 % it does not work at all What is the
therapeutic outcome by using fourth generation progesterone Dienogest in
endometriosis or fibroid? Which Drug to prescribe in which
sequence?? Some people claim A) to use GNRHA as initial therapy B)
some advocates to use Dienogest as initial therapy C) others advocate to use GnRH initially for
six months followed by Dienogest for 6 months.
The
indications for dienogest:-.
A) Endometriosis:
- Dienogest have a special role in management of endometriosis, particularly for pts who do not want surgery. There
is no need of GNRH. But, dienogest is not useful for fibroid.
Dienogest cab work in women with bilateral endometriomas, In fact one had a
case 5 cm was advised surgery for
secondary infertility. I had put her on Dienogest. For 4 months. She developed amenorrhea.
Now she is 16 weeks pregnant after stoppage of dienogest.. USG is now normal.
Her ovaries have reduced considerably in size.
Dienogest has helped in some of patients with
endometriosis. 2-3 cms cysts have disappeared with good pain relief. But there is equal number where it didn't
help. Have put some on it post op when fertility is not an issue. One
girl with bladder
endometriosis is on it for a year with no complaints. She was
troubled by it for 4-5 yrs. Dienogest
gives good results in 50 % cases of endometriosis. In the other 50 % it does
not work at all. So no harm in
trying. But found that one patient on dienogest doing very well regarding her
pain in endometriosis.
B) Adenomyosis:
- We have tried for Adenomyosis; rather, now it is the first line drug for me
in Adenomyosis related implantation failure. 6 months to even a year and then
one can plan ET in HRT or even natural cycle. It , hopefully will work, although it cannot be generalized.
Cases have to be selected
C) Use
in AUB?? Question is can it be used like other progesterone in heavy
bleeding (AUB)? To me it appears , dienogest will work, Yes, since its
progesterone.
D) Dysmenorrhoea:-Even
I have been giving dienogest for some time to my pts, but irregular spotting is
one problem I noticed definitely with good results in dysmenorrhoea and cyst
size decreased only but not completely regressed. Dienogest gives good results
in 50 % cases of endometriosis. In the other 50 % it does not work at all. So no
harm in trying.
H) Side effects?? Can there be irregular
bleeding with dienogest??Ans: Yes, This is a distinct minor but acceptable side effect.Prior counselling is desirable .This will avoid noncompliance OF DRUG.
Some woman may have irregular bleeding with
dienogest which is a common side effect with it (Dienogest)... many may be amenorrhoeic , Not to be used in Postmeno women.with bleeding .,
Dienogest has been used as a contraceptive with
estrogen for years. As only progesterone it is new. Irregular bleeding is a
side effect
D) Dose:-They recommend minimum 2 mg OD
but can be given up to 10 mg . To be given for 6 moths.
F) What about contraception if it doesn't
want pregnancy while on dienogest. Ans: Dienogest itself is contraceptive.
What about Cabergolin ?? Cabergolin is effective but not as effective as dienogest in cases of
endometriosis. Dienogest is definitely effective in dysmenorrhoea
associated with endometriosis
Should it given continuously or after every withdrawal
bleed for 6 months?Ans: Not yet determined.
.
.
No comments:
Post a Comment