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

## Case 7 was submitted to laparotomy at month 8 because of bilateral ovarian abscess. See Fig. 2.

\* *P* < 0.01 versus baseline.

484 Endometriosis - Basic Concepts and Current Research Trends

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

The data were collected from 13 perimenopausal patients sequentially treated with leuprolide acetate (1.88mg monthly, Takeda Pharmaceutical, Japan) for 6 months and dienogest (2mg/day, Mochida Pharmaceutical, Japan) for 6 months against endometriosis in our patient clinic from January 2008 to May 2011. In this retrospective chart review, we included all perimenopausal patients complicated with a myoma node measuring > 4cm or with adenomyosis measuring >10 cm at the age 46-52 years. Measurements of nodes or total uterine volume using MRI were performed at baseline and during treatment at months 6 and 12. For

Size of myoma or overall uterine was measured at three diameters (transverse, vertical and anterior-posterior) with MRI. Half of multiplied three diameters was accepted as size of myomas and uterus. These measurements were repeated 6 and 12 months after starting the

Pared t-*t*ests were used to analyze in each size change from baseline. Statitstical significance

1 48 Intramural 108.6 78.6 (72.2) 80.6 (74.0) 2 49 Intramural 72.8 61.9 (85.0) 58.6 (80.5)

5**#** 52 Adenomyosis 117.5 56.3 (47.8) 50.3 (42.8) 6 50 Subserosal 88.7 85.6 (96.5) 81.7 (92.1)

Table 1. Myoma volume change during sequential treatment with GnRHa and dienogest

Average 49.9 ± 2.3 87.1 ± 23.5 57.5 ± 19.3\*

Total myoma volume (cm3) (% of baseline)

> After dienogest treatment

> > 57.7 ± 17.3\* (68.4 ± 18.1)

treatment

(67.6 ± 19.5)

Baseline After GnRHa

(multiple) 45.6 33.6 (73.7) 36.9 (80.9)

(multiple) 89.3 42.7 (47.8) 50.9 (57.0)

(multiple) 87.2 43.6 (50.0) 45.2 (51.8)

tecknical reasons, leuprolide acetate was supplied in vials and dienogest in tablets.

perimenopausal women until leading to a natural menopause.

**2. Materials and methods 2.1 Reproductive chart review** 

therapy.

**2.2 Statistics** 

was defined as *P* < 0.05.

Case No. Age

(years) Myoma type

3 46 Intramural

4 52 Intramural

<sup>7</sup>**##** 52 Subserosal

Fig. 1. Total uterine volume change in the patient with myoma during sequential treatment with GnRHa and dienogest (case 6 of Table 1).

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