Daily Vaginal Application of Dienogest (Visanne©) for 3 Months in Symptomatic Deeply Infiltrating Rectovaginal Endometriosis: A Possible New Treatment Approach?

Andreas D. Ebert
Case reports in obstetrics and gynecology · 2018 · vol. 2018(1) , pp. 8175870 · doi:10.1155/2018/8175870 · PMID:29862105 · W2802904945
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

A 27-year-old patient with symptomatic rectovaginal endometriosis experienced symptom relief and reduced side effects with 3 months of daily vaginal dienogest, though physical examination showed minimal changes.

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Abstract

A 27‐year‐old patient suffering from deeply infiltrating rectovaginal endometriosis was treated with 2 mg/day dienogest vaginally for 3 months. The therapy was tolerated very well. The patient reported less side effects compared to the oral use of dienogest. After 3 months of dienogest treatment, the rectovaginal gynecological examination identified the visible vaginal part of endometriosis in remission. The firm endometriosis node approximately 3 cm in size and approximately 10 cm ab ano was still palpable, but it was much less painful. The laboratory values for luteinizing hormone (LH) and follicle‐stimulating hormone (FSH) were unremarkable, with an LH/FSH quotient of 0.7 during dienogest treatment, while 17‐ β estradiol and progesterone were suppressed. At palpation and vaginal ultrasonography, there was no change in the findings before and after 3 months of dienogest treatment, but the patient was now de facto asymptomatic. To the best of our knowledge, this is the first report of a vaginal dienogest treatment in symptomatic deeply infiltrating rectovaginal endometriosis. Vaginal administration of dienogest should receive further investigation in pharmacokinetic and clinical studies.

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endometriosisbowel_endometriosis

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