{"paper_id":"ae49c318-c557-46db-87b9-f3d63d5976e1","body_text":"Abstract\nPurpose\nWe aim to provide a comprehensive overview of the role of the vagina as a route for drug delivery and absorption, with a particular focus on the use of vaginal hormonal compounds for the treatment of deep infiltrating symptomatic endometriosis.\nMethods\nA MEDLINE search through PubMed was performed to identify all published studies in English language on vaginal hormonal treatments for symptomatic endometriosis.\nResults\nMain advantages of the vaginal route include avoidance of the hepatic-first pass metabolic effect, the possibility of using lower therapeutic dosages, and the reduction of side effects compared with the oral administration. Studies on endometriosis treatment mainly focused on the use of vaginal danazol (n = 6) and the contraceptive vaginal ring (n = 2). One pilot study evaluated the efficacy of vaginal anastrozole in women with rectovaginal endometriosis. Most investigations evaluated the vaginal use of hormonal agents in women with deep infiltrating endometriosis/rectovaginal endometriosis. Overall, a substantial amelioration of pelvic pain symptoms associated with endometriosis was observed, particularly of dysmenorrhea. A significant reduction in rectovaginal endometriotic nodule dimensions measured at ultrasound examination was detected by some but not all authors.\nConclusions\nThe vaginal route represents a scarcely explored modality for drug administration. High local hormonal concentrations might achieve a greater effect on endometriotic lesions compared with alternative routes. Future studies should focus on the use of the vagina for delivering target therapies particularly in patients with deeply infiltrating rectovaginal lesions.\nSimilar content being viewed by others\nReferences\nLete I, Luis Dueñas JL, Esplugues JV, Marti-Cabrera M (2010) Is the vagina an adequate route for the administration of hormonal contraceptives? 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Arch Gynecol Obstet 284:105–110. doi:10.1007/s00404-010-1599-6\nAuthor information\nAuthors and Affiliations\nContributions\nLB: Project development, Data collection, Manuscript writing/editing. CL: Data collection, Manuscript editing. EM: Data collection. GB: Data collection, Manuscript editing. NB: Data collection. PV: Project development, Manuscript writing/editing.\nCorresponding author\nEthics declarations\nFunding\nThis article was financed by Italian fiscal contribution “5x1000”—Ministero dell’Istruzione, dell’Università e della Ricerca—devolved to Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy.\nConflict of interest\nAll authors declare that have no conflict of interest.\nEthical approval\nThis article does not contain any studies with human participants or animal performed by any of the authors.\nRights and permissions\nAbout this article\nCite this article\nBuggio, L., Lazzari, C., Monti, E. et al. “Per vaginam” topical use of hormonal drugs in women with symptomatic deep endometriosis: a narrative literature review. Arch Gynecol Obstet 296, 435–444 (2017). https://doi.org/10.1007/s00404-017-4448-z\nReceived:\nAccepted:\nPublished:\nIssue date:\nDOI: https://doi.org/10.1007/s00404-017-4448-z","source_license":"CC0","license_restricted":false}