MRI changes of case 5 are presented as a representative prolile in Fig.1.

dienogest therapy).

\* *P* < 0.01 versus baseline.

Fig. 2.

and Dienogest of Endometriosis-Associated Uterine Myoma and Adenomyosis 485

The patients were sequentially treated with leuprolide acetate (1.88mg monthly) for 6 months and dienogest (2mg daily) for 6months. Measurements of nodes using MRI were performed at baseline, during treatment at months 6 (after GnRHa therapy) and 12 (after

## Case 7 was submitted to laparotomy at month 8 because of bilateral ovarian abscess. See

Fig. 1. Total uterine volume change in the patient with myoma during sequential treatment

The patient was sequentially treated with leuprolide acetate (1.88mg monthly) for 6 months and dienogest (2mg daily) for 6months. Sagittal T2-weighed MR imagings before (a),

Of 13 endometriosis patients sequentially treated with GnRHa and dienogest, 7 were associated with coexistent myoma node and adenomyosis; 4 intramural and 2 subserosal types and 1 of adenomyosis. Mean age was 49.9 ± 2.3 (46-52)(Table 1). Volume changes of total myoma and adenomyosis are presented as the percentage change from baseline in Table 1. A remarkable reduction in myoma /adenomyosis volume from baseline was noted:

months 6 (after GnRHa therapy) (b) and 12 (after dienogest therapy)(c)

with GnRHa and dienogest (case 6 of Table 1).

**3. Results** 

features (Huang *et al*, 2010), these successful trials on endometriosis support that the use of dienogest inhibits myoma and adenomyosis growth. While evaluating superiority of dienogest in women with endometriosis, we have found significant shrinkage of myoma nodes coexisted with endometriosis over several months during an administration of dienogest (Ichigo *et al*, 2011). In this paper, we attempted to prevent their regrowth after discontinuation of GnRHa using dienogest. This retrospective study may be the first study that examined the efficacy and safety of dienogest following GnRHa therapy in perimenopausal women until leading to a natural menopause.
