Dienogest as preferred maintenance drug after lauromacrogol sclerotherapy for ovarian endometriosis cysts: a retrospective cohort study

Ovarian endometriotic cyst (OEC) is a common chronic gynecological disease in women of reproductive age, which is closely associated with chronic pelvic pain and infertility. Previous single-modality treatment, such as medications, surgical enucleation, and puncture sclerotherapy are at risks for incomplete lesion removal or functional impairment of the ovarian. Therefore, postoperative combined medical therapy has become a research hotspot in clinical practice. This study aims to retrospectively analyze the clinical efficacy of ultrasound-guided sclerotherapy with lauromacrogol combined with different maintenance medications for OEC, and to identify the optimal postoperative medication regimen.

A retrospective cohort study was conducted. A total of 185 patients diagnosed with OEC in the Day Ward of our department from September 2021 to December 2025 were enrolled initially. After excluding 17 cases lost to follow-up and 15 due to other reasons, 153 patients were finally included. According to the type of postoperative maintenance medication regimens, they were divided into a dienogest group (n=55), a gonadotropin-releasing hormone agonist (GnRH-a) group (n=30), a dydrogesterone group (n=33), and a control group without pharmacological treatment (n=35). All of them were followed up for 6 months. Transvaginal color Doppler ultrasound examination was performed to measure the maximum diameter and volume of OEC before, and at 1, 3, and 6 months after operation, and the serum carbohydrate antigen 125 (CA125) levels were detected by chemiluminescence immunoassay at the same time points. Baseline characteristics of the patients were compared across the 4 groups. The efficacy and short-term complications in each group after lauromacrogol sclerotherapy were summarized. A mixed-effects model for repeated measures (MMRM) was adopted to analyze differences in the observed indicators at each follow-up time point.

① There were no significant differences in baseline data among the 4 groups except for OEC cyst fluid viscosity (mild: 31 cases, 20.26%; moderate: 69 cases, 45.10%; severe: 53 cases, 34.64%; P=0.008). ② Puncture sclerotherapy was ineffective in 11 cases (7.19%), including 3 cases in the control group, 5 in the dienogest group, 1 in the GnRH-a group, and 2 in the dydrogesterone group. One patient in the dydrogesterone group still failed to respond to the drug after 6 months of medication. The main short-term postoperative complications were fever [32.03% (49/153)], abdominal pain [15.03% (23/153)] and puncture site bleeding [5.88% (9/153)]. ③ The maximum diameter and volume of OEC in all groups were decreased gradually after operation, with no significant intergroup difference at 1 month postoperatively. At 3 months after operation, the diameter (95%CI: 3.45 to 15.65, P=0.0151) and volume (95%CI: 5.04 to 23.34, P=0.0167) were significantly lower in the dienogest group than the control group. The GnRH-a group showed statistically significant differences in the maximum diameter (95%CI: 5.21 to 18.62, P=0.0035) and the cyst volume (95%CI: 4.83 to 25.87, P=0.0292), with even more pronounced differences at 6 months postoperatively [dienogest group (95%CI: 3.66 to 15.22, P=0.0099; 95%CI: 5.89 to 19.17, P=0.0019); GnRH-a group (95%CI: 7.44 to 21.47, P=0.0005; 95%CI: 5.99 to 21.23, P=0.0038)]. No significant differences were found among the 3 medication groups, and either between the dydrogesterone group and other groups. ④ Preoperative serum CA125 levels were mostly elevated, but no significant differences were observed across groups. Postoperative CA125 levels were decreased in all groups. The CA125 levels were significantly decreased at 1 month after operation in the GnRH-a group (95%CI: 39.99 to 87.81, P<0.0001) and dydrogesterone group (95%CI: 18.00 to 53.40, P=0.0004), with no significant intergroup difference. After continuous maintenance medication, the dienogest group (95%CI: 12.68 to 37.72, P=0.0004), the GnRH-a group (95%CI: 32.67 to 58.93, P<0.0001), and the dydrogesterone group (95%CI: 23.10 to 42.50, P<0.0001) all showed significant differences compared with their own 1-month postoperative controls, but no significant intergroup differences were observed.

Maintenance therapy with dienogest or GnRH-a following ultrasound-guided lauromacrogol sclerotherapy demonstrates equally significant efficacy for OEC. OEC volume may serve as a superior imaging indicator for therapeutic response assessment.