Vaginal danazol in women with rectovaginal endometriosis and pain symptoms persisting after the insertion of the levonorgestrel-releasing intrauterine device

Abstract

OBJECTIVE: To determine whether vaginal danazol improves pain symptoms caused by rectovaginal endometriosis persisting after the insertion of the Lng-IUD. DESIGN: Prospective study. MATERIALS AND METHODS: This study included women of reproductive age with rectovaginal endometriosis who had pain symptoms persisting after the insertion of the Lng-IUD. The patients were dissatisfied with the Lng-IUD when enrolled in the study. Vaginal danazol (100 mg/d) was self-administered for 6 months. Dysmenorrhea, deep dyspareunia, chronic pelvic pain and dyschezia were assessed before the insertion of the Lng-IUD and then every 3 months during therapy. The intensity of pain symptoms before and after administration of danazol was compared by paired t-test and signed rank test. RESULTS: Out of 16 women fitting the criteria for inclusion in the study, 13 (81.3%) accepted to participate. At the time of enrollment in the study, the patients had used the Lng-IUD for 8.2 (± 2.4) months. After 6-month treatment with vaginal danazol, 10 women (76.9%) were satisfied with the treatment; three women were dissatisfied. After 3-month treatment with vaginal danazol, there was a significant decrease in the intensity of dysmenorrhea (p < 0.001), chronic pelvic pain (p < 0.001) and deep dyspareunia (p = 0.010); there was a non-significant trend for a lower intensity of dyschezia (p = 0.098). After 6-month treatment with vaginal danazol, the intensity of dysmenorrhea (p < 0.001), chronic pelvic pain (p = 0.001) deep dyspareunia (p = 0.002) and dyschezia (p = 0.006) was significantly lower than before the administration of danazol. The following adverse effects were observed: seborrhea, oily hair or acne (n = 4), headache (n = 2), weight gain (n = 2), vaginal irritation (n = 1). 8 women (61.5%) continued the double-drug treatment after the completion of the study. CONCLUSION: In women with rectovaginal endometriosis, vaginal danazol decreases the severity of pain symptoms persisting after the insertion of the Lng-IUD.