Manajemen Jangka Panjang Endometriosis: Dapatkah Progestin Menjadi Andalan?
Abstract
Latar belakang: pada tahun 2014 The Practice Committee of The American Society of Reproductive Medicine menyebutkan bahwa endometriosis merupakan penyakit kronis yang memerlukan penanganan jangka panjang dengan titik berat pada terapi medikamentosa. Progestin merupakan modalitas terapi yang berpotensi digunakan dalam jangka panjang. Dienogest merupakan progestin turunan 19-nortestosteron dengan pengaruh pada endometrium dan antiinflamasi yang kuat merupakan pilihan untuk terapi jangka panjang endometriosis.
Metode: telaah pustaka.
Hasil: dalam manajemen endometriosis, progestin digunakan dalam terapi jangka panjang serta untuk mencegah rekurensi. Penggunaan dienogest jangka panjang menurunkan skor visual analogue scale secara bermakna dari beberapa penelitian. Analisis efektivitas-biaya menunjukkan profil penghematan biaya yang lebih baik pada dienogest dibandingkan goserelin. Rekurensi endometriosis pasca operasi menurun secara bermakna pada wanita yang mendapat terapi dienogest. Dalam suatu network meta-analysis diketahui bahwa kombinasi agonis GnRH + dienogest diharapkan menjadi pilihan terbaik pencegahan rekurensi. Dari dua penelitian dengan subjek wanita Asia, efek samping dienogest terjadi pada sekitar 13,27% - 31,5% subjek dan umumnya bersifat ringan. Perubahan pola perdarahan uterus merupakan hal yang sering disampaikan subjek. Kepadatan mineral tulang mengalami penurunan pada pemberian dienogest namun mengingat pentingnya pencegahan rekurensi dan menghindari operasi ulang, keputusan penggunaan dienogest sebaiknya tidak hanya didasarkan pada hal ini saja.
Simpulan: data menunjukkan bahwa dalam konsep terapi jangka panjang, progestin merupakan modalitas yang amat penting. Dienogest merupakan salah satu pilihan untuk manajemen jangka panjang endometriosis. Pengawasan penggunaan progestin harus selalu diperhatikan untuk mengupayakan diperolehnya hasil yang optimal.
The Long Term Management Of Endometriosis: are Progestins the Reliable Choice?
Abstract
Background: in 2014, The Practice Committee of The American Society of Reproductive Medicine stated that endometriosis should be viewed as a chronic disease that requires a lifelong management, with focus on progestins. Dienogest, a 19-nortestosterone derivative, is a progestin compound with strong endometrium effects and antiinflammatory property that may become an option in long term management of endometriosis.
Method: literature review
Results: progestins might be applied in both long term management and prevention of recurrence of endometriosis. The significant reduction of visual analogue scale score were found in several study. The cost-effectiveness analysis reveals better cost-saving profile of dienogest when compared with goserelin. Women who received postoperative dienogest treatment have reduced incidence of recurrence. In one network meta-analysis study, the GnRH agonist + dienogest combination revealed the best option for preventing recurrence. The adverse effects of dienogest from 2 Asian studies range from 13.27% - 31.5%, mostly mild cases. Changes in uterine bleeding pattern were the most common reported side effects. The bone mineral density decreased after dienogest treatment, however, considering the benefit of dienogest for preventing recurrence and repeated operation, the use of dienogest should not be solely based on bone mineral density changes.
Conclusion: progestin is the important mainstay of long term therapi in endometriosis. Dienogest is an option in long term management of endometriosis. However, monitoring of their usage should be an important aspects to ensure optimal outcomes are achieved.
Key words: bleeding pattern, bone mineral density, dienogest, endometriosis, long term management, progestins.
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DOI: http://dx.doi.org/10.24198/obgynia.v6i2.527
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