Objective To analyze the factors affecting recurrence in patients with endometriosis treated with dienogest.Methods The medical records of 129 patients with endometriosis admitted to the Northwest Women and Children's Hospital from September 2022 to February 2024 were retrospectively analyzed. All patients were treated with laparoscopic surgery combined with dienogest and were followed up for 1 year. They were divided into the recurrent group and the non-recurrent group according to whether they relapsed after treatment. The clinical data of the two groups were compared to analyze the influencing factors for recurrence in patients with endometriosis after dienogest treatment.Results During one year of follow-up, the recurrence rate among 129 patients with endometriosis was 10.08% (13/129). The maximum cyst diameter, the revised American Fertility Society (r-AFS) score, and the proportion of stage Ⅲ-Ⅳ disease in the recurrence group were all higher than those in the non-recurrence group, while the age of patients and the postoperative pregnancy rate in the recurrence group were lower than those in the non-recurrence group (P < 0.05). Logistic regression analysis showed that large maximum cyst diameter [O^R = 3.865 (95% CI: 1.181, 12.650) ], high r-AFS score [O^R = 4.108 (95% CI: 1.968, 8.574) ], and stage Ⅲ-Ⅳ disease [O^R = 3.557 (95% CI: 1.087, 11.642) ] were risk factors for recurrence in patients with endometriosis after dienogest treatment (P < 0.05), and that young age [O^R = 0.270 (95% CI: 0.130, 0.564) ] and postoperative pregnancy [O^R = 0.262 (95% CI: 0.080, 0.856) ] were protective factors (P < 0.05).Conclusion Endometriosis patients with a larger maximum cyst diameter, higher r-AFS score, more advanced surgical stage, younger age, and no postoperative pregnancy are at higher risk of recurrence after dienogest treatment, which warrants clinical attention.