Deep Infiltrating Endometriosis Treatment with Dienogest: A Pilot Study

Abstract

Background The aim of this study was to evaluate treatment with dienogest in women with deep infiltrating endometriosis (DIE). Methods A prospective cohort study was conducted at the Department of Gynecology and Obstetrics in the University of Campinas (UNICAMP), Brazil. The study included 16 women with DIE and pain which was not responsive to treatment with other progestins, who were treated with dienogest, and who attend a tertiary university hospital in 2013. Scores for pain complaints, quality of life, sexuality and extent of endometriotic lesions were evaluated before and 6 months after treatment. Statistical methods included the Wilcoxon matched-pairs test, which was used for the analysis of the quantitative data, and the relationship between them was tested by the Spearman correlation index. Results Women were a mean 36 ± 6.2 years old and reported onset of painful symptoms at a mean 29.9 ± 8.6 years of age. A significant reduction in dysmenorrhea, acyclic pelvic pain, dyspareunia and defecation pain was reported after treatment. There was no significant change in the assessment of quality of life or the Female Sexual Function Index. Intestinal lesions, which had an initial 3.4 ± 4.2 cc average size, decreased to 1.6 ± 1.8 cc, but this reduction was not statistically significant. The most common side effects were headaches and acne. Conclusions Dienogest can be used for clinical pain control in DIE.

Medical treatment in the management of deep endometriosis infiltrating the proximal rectum and sigmoid colon: a comprehensive literature review

“…Eight studies were case series (seven prospective, one retrospective) (10)(11)(12)(13)(14)(32)(33)(34), two were retrospective cohort studies (29,35) and four were case reports (36-39) ( Table 1). Eight studies were case series (seven prospective, one retrospective) (10)(11)(12)(13)(14)(32)(33)(34), two were retrospective cohort studies (29,35) and four were case reports (36-39) ( Table 1).…”

“…A total of 420 women with large bowel endometriosis treated with combined oral contraceptives (OC), progestins, gonadotropin releasing-hormone (GnRH) agonists, and aromatase inhibitors have been described in 14 articles published in 2000-2018. Eight studies were case series (seven prospective, one retrospective) (10)(11)(12)(13)(14)(32)(33)(34), two were retrospective cohort studies (29,35) and four were case reports (36-39) ( Table 1). The precise location of lesions has not been systematically specified, and sometimes what was exactly intended with "colorectal endometriosis" is unclear.…”

“…According to some authors, excisional surgery is the best solution for women with symptomatic intestinal endometriosis, as medical treatments may exert an effect on the endometrial and smooth muscle component of the nodule, but not on the extensive fibrotic component, thus providing limited benefit (3,(7)(8)(9). However, several investigators observed substantial improvements of bowel symptoms during hormonal treatment (10)(11)(12)(13)(14). Disentangling the uncertainties of the role of medical therapy in women with infiltrating bowel endometriosis seems exceedingly important, as excisional procedures with opening of the bowel lumen are generally effective in relieving intestinal symptoms but are also associated with severe short-and long-term complications in about one of 10 patients (for example, intestinal leakage, anastomosis dehiscence, septic peritonitis, rectovaginal fistula formation, bowel anastomosis stenosis, iatrogenic neurologic bladder dysfunction with need for long periods of selfcatheterization, and postoperative constipation and de novo rectal dysfunction) (16)(17)(18)(19)(20)(21)(22)(23)(24)(25).…”

“…At the 1-year evaluation, 60% of participants were satisfied or very satisfied with their treatment, 20% were uncertain and 20% were either dissatisfied or very dissatisfied.The effect of dienogest in patients with bowel endometriosis was assessed by the same research group in two case series. Yela et al(13) treated…”

<p>Bowel Endometriosis: Current Perspectives on Diagnosis and Treatment</p>

“…Dienogest is the only progestogen approved in Europe, Japan, Australia, and Singapore for long-term treatment of endometriosis and its use has been attributed to reduction in pain, nodule size and quality of life improvement. [76][77][78] A recent prospective Korean study of 40 women of reproductive-age highlights a possible association between long-term dienogest treatment (2 mg/d for at least 12 months) and significant bone demineralization, that occurs in 75% of the patients occurring mainly in the first 6 months of therapy. 79 Norethindrone acetate (NETA) 2.5 mg/d has also been proposed as a possible alternative, showing significant improvement in pain and cyclical symptoms related to menses; it shares with dienogest similar adverse effects, except its effect on bone, and has a more favorable cost analysis.…”