The symptom-modifying effect of dienogest in patients with genital endometriosis who have proliferative changes in the mammary glands

Modern studies show that in different countries 15–70% of patients with genital endometriosis (GE) have concomitant breast pathology, which is considered a manifestation of overlap syndrome. This category of patients requires a detailed examination of the mammary glands when choosing hormonal therapy, as well as more careful observation during treatment.The objective: to assess the symptom-modifying effect of dienogest in patients with GE who have proliferative changes in the mammary glands.Materials and methods. 226 women of reproductive age with GE were examined. Staging of endometriosis was performed according to the revised version of the American Society of Reproductive Medicine classification after laparoscopic intervention. Diagnosis, treatment and clinical monitoring of patients were carried out in compliance with modern bioethical requirements, as well as in accordance with the recommendations of the World Health Organization and the American College of Obstetricians and Gynecologists. All patients had ultrasound examination of the mammary glands. Changes in functional status were assessed using the Breast imaging reporting and data system (BI-RADS) scale. Endopain questionnaire was used to determine the intensity of pain syndrome in GE. As a symptom-modifying drug, patients were prescribed dienogest 2 mg once a day for 24 weeks. The presence of clinical manifestations of GE was determined before and after treatment.Results. Proliferative changes in the tissues of the mammary gland were detected in 65.6% of the examined patients with GE. As the stage of endometriosis progresses, the severity of proliferative changes in the mammary glands increases (positive correlation of medium strength with the stage of external GE was found, r = 0.53; p < 0.05). In the selected cohort of patients, the use of dienogest 2 mg for 6 months led to a decrease in the intensity, and in many cases to the disappearance of chronic pelvic pain syndrome and other manifestations of the disease: algodysmenorrhea and dyspareunia.Conclusions. The study confirmed the world data that the overlap syndrome of GE and dyshormonal breast diseases is a common clinical phenomenon. It has been established that with increasing stage of endometriosis, there is an increase in the breast pathologies frequency. In the treatment of patients with overlap syndrome of GE and dyshormonal breast diseases, the effectiveness of dienogest has been confirmed, as evidenced by the regression of clinical symptoms of GE, in particular, a decrease in the intensity of chronic pelvic pain syndrome. It is important that hormonal therapy for endometriosis has demonstrated a high safety profile, because it not only does not provoke the occurrence of side effects, but also does not have an undesirable effect on the functional state of the mammary glands.