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Is it safe to use dienogest long-term?

Use of dienogest in endometriosis: a narrative literature review and expert commentary.

Efficacy with long-term dienogest therapy for endometriosis

“Long-term treatment of endometriosis with dienogest 2mg (>15 months) should continue for as long as needed by the individual woman (e.g. until pregnancy is desired, disease recurs, or side effects occur), based on local treatment labels.”

General safety profile with long-term dienogest therapy for endometriosis

“The general safety profile of dienogest indicates that it is well tolerated in patients with endometriosis. Administration of dienogest for up to 5 years has also demonstrated a favorable safety and tolerability profile”

· Bone health

“There is no evidence to suggest the need for additional monitoring or supplements for bone health with dienogest treatment…..There is no evidence to suggest an increased risk of fracture in later life.”

“Changes in BMD should not prevent long-term treatment with dienogest, but patients should be advised about the risks of decreased BMD, particularly if already predisposed to osteoporosis due to factors including chronic steroid use, previous fragility fractures, smoking, and malabsorption conditions, such as inflammatory bowel disease.”

· Breast health

“In terms of cancer risk, women receiving dienogest do not need to be treated or monitored differently from other women. Women should be offered appropriate counseling and time to ask questions. Ovarian masses should be monitored and treated according to published clinical practice guidelines, which aim to minimize morbidity with conservative management, laparoscopic techniques, and appropriate referral.”

· Comparison of combined oral contraceptives and dienogest

“Data support the efficacy of COCs in reducing dysmenorrhea in women with endometriosis but not the relief of other typical pain symptoms (e.g. dyspareunia, non-cyclic pelvic pain)…..Evidence supports the efficacy of dienogest 2mg in reducing multiple types of endometriosis-associated pain, including pelvic pain, dysmenorrhea, dyspareunia, dysuria, and dyschezia.”


Murji A, Biberoğlu K, Leng J, Mueller MD, Römer T, Vignali M, Yarmolinskaya M. Use of dienogest in endometriosis: a narrative literature review and expert commentary. Curr Med Res Opin. 2020 May;36(5):895-907. doi: 10.1080/03007995.2020.1744120. Epub 2020 Mar 31. PMID: 32175777.


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