Short-term effectiveness of gonadotropin-releasing hormone agonist combined with dienogest sequential therapy after endometriosis surgery

Objective To compare the short-term effectiveness of gonadotropin-releasing hormone agonist (GnRH-a) combined with dienogest (DNG) sequential therapy versus DNG alone and GnRH-a alone after endometriosis surgery.Methods A total of 171 endometriosis patients who were admitted to Huai'an Maternal and Child Health Care Hospital and underwent laparoscopy from October 2019 to April 2022 were enrolled. According to the random number table method, they were randomly divided into three groups (n=57):a DNG group (where patients were treated with DNG alone), a GnRH-a group (where patients were treated with GnRH-a alone) and a GnRH-a+DNG group (where both GnRH-a and DNG sequential therapy were used). Then, their clinical effectiveness, adverse reactions, and quality of life at postoperative 6 months and 1 year were compared.Results There were no statistical differences in therapeutic effect and Visual Analogue Scale (VAS) score among the three groups at postoperative 6 months and 1 year (all P>0.05). The recurrence rate in the GnRH-a+DNG group was significantly lower than those in the DNG group and the GnRH-a groups at postoperative 1 year (all P<0.05). Both the GnRH-a+DNG group and the DNG group showed significantly lower Kupperman scores than the GnRH-a group at postoperative 6 months and 1 year (all P<0.05). Both the GnRH-a+DNG group and the DNG group presented significantly lower lumbar bone mineral density (L-BMD) levels than the GnRH-a group at postoperative 6 months and 1 year (all P<0.05). Both the GnRH-a+DNG group and the GnRH-a group showed significant decreases in the vaginal bleeding rate at postoperative 1 year (all P<0.05). The Endometriosis Health Profile-30 (EHP-30) score in the GnRH-a+DNG group was significantly lower than those in the DNG group and the GnRH-a group at postoperative 6 months and 1 year (all P<0.05).Conclusions The combination of GnRH-a and DNG sequential therapy can reduce the recurrence rate of endometriosis patients at postoperative 1 year, improve vaginal bleeding patterns, relieve menopausal symptoms and osteoporosis, and improve the quality of life.