Abstract
Background: Rectosigmoid endometriosis is a severe form of deep endometriosis, which may be responsible for pain symptoms and a wide range of intestinal complains such as diarrhea, constipation, and abdominal cramping. The primary objective of this study was to evaluate the efficacy of long-term therapy with dienogest (DNG), a fourth-generation progestin, for ameliorating quality of life, pain, and intestinal symptoms of patients affected by rectosigmoid endometriosis. Methods: A retrospective analysis of a prospectively collected database was done on patients with endometriotic nodules infiltrating at least the muscular layer of the rectosigmoid wall with an estimated colorectal stenosis <60%. The diagnosis of rectosigmoid endometriosis was based on transvaginal ultrasonography. Patients accepting to participate in the study received continuous oral treatment with DNG at the dose of 2 mg/day. Results: At the end of the first year of treatment, a significant decrease in dysmenorrhea (P < 0.001), chronic pelvic pain (P < 0.001), dyspareunia (P < 0.001), dyschezia (P < 0.001), and in intestinal symptoms (P < 0.001) was observed. A progressive increase of the Endometriosis Health Profile-30 (EHP-30) and Gastrointestinal Quality of Life Index (GIQLI) scores was observed in the first two years of therapy (P < 0.001 and P < 0.001, respectively). Improvements of patients’ symptoms and quality of life were maintained until the end of the study. The regimen was well tolerated, and the frequency and amount of irregular bleeding decreased as treatment progressed. Conclusion: The current study confirms the efficacy of long-term therapy with DNG for treating symptoms caused by rectosigmoid endometriosis.
Highlights
Rectosigmoid endometriosis is defined by the presence of deep endometriotic nodules infiltrating at least the muscularis propria of the rectosigmoid wall; it may affect between 4% and 37% of women with endometriosis [1,2]
The diagnosis of rectosigmoid endometriosis was based on transvaginal ultrasonography (TVS)
Several previous studies investigated the use of hormonal drugs, such as low-dose oral contraceptive pill [15], norethisterone acetate (NETA) [8,9], desogestrel, triptorelin [10], and letrozole [8] for treating patients with bowel endometriosis, demonstrating that these hormonal therapies are effective in ameliorating pain, intestinal symptoms, and global quality of life of these women
Summary
Rectosigmoid endometriosis is defined by the presence of deep endometriotic nodules infiltrating at least the muscularis propria of the rectosigmoid wall; it may affect between 4% and 37% of women with endometriosis [1,2]. Transvaginal ultrasonography can accurately diagnose the presence of rectosigmoid endometriosis and estimate the depth of infiltration of the nodules in the intestinal wall [4] For this reason, it should be considered the first-line investigation in patients with suspicion of deep endometriosis [5]. Women affected by smaller intestinal nodules without evidence of significant stenosis of the bowel lumen or subocclusive symptoms can be treated by medical therapies. These treatments can improve patient’s pain and intestinal complains, avoiding or postponing surgery [8,9,10]. Conclusion: The current study confirms the efficacy of long-term therapy with DNG for treating symptoms caused by rectosigmoid endometriosis
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