Hormonal Treatment of Bowel Endometriosis

Colorectal surgery is required when bowel endometriosis cause subocclusive or occlusive symptoms. Several studies showed that in the other patients, hormonal therapies can improve both pain and intestinal complaints in about two-thirds of women with bowel endometriosis. Progestins (such as norethindrone acetate, dienogest, and desogestrel) and combined estroprogestin combinations are efficacious in the treatment of symptoms caused by bowel endometriosis, they are safe and well tolerated. Gonadotrophin-releasing hormone agonists (GnRH-a) and aromatase inhibitors (AIs) can improve the symptoms caused by bowel endometriosis but they cause relevant adverse effect which limit their long-term use. Patients receiving long-term hormonal therapy must be monitored during treatment, because intestinal nodules may progress despite the use of these therapies. Patients receiving hormonal therapies must be informed that this treatment induces only temporary relief of symptoms which usually recur few months after discontinuation of therapies; thus, these therapies are not expected to be definitively curative. Based on this, patients choosing the hormonal therapy should continue the treatment for many years, ideally until a pregnancy is desired or the physiologic menopause ensues. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others

Vercellini P, Crosignani PG, Somigliana E, Berlanda N, Barbara G, Fedele L. Medical treatment for rectovaginal endometriosis: what is the evidence? Hum Reprod. 2009;24(10):2504–14. Ferrero S, Alessandri F, Racca A, Leone Roberti Maggiore U. Treatment of pain associated with deep endometriosis: alternatives and evidence. Fertil Steril. 2015;104(4):771–92. Vercellini P, Buggio L, Somigliana E. Role of medical therapy in the management of deep rectovaginal endometriosis. Fertil Steril. 2017;108(6):913–30. Donnez J, Nisolle M, Gillerot S, Smets M, Bassil S, Casanas-Roux F. Rectovaginal septum adenomyotic nodules: a series of 500 cases. Br J Obstet Gynaecol. 1997;104(9):1014–8. Remorgida V, Ragni N, Ferrero S, Anserini P, Torelli P, Fulcheri E. How complete is full thickness disc resection of bowel endometriotic lesions? A prospective surgical and histological study. Hum Reprod. 2005;20(8):2317–20. Noel JC, Chapron C, Bucella D, Buxant F, Peny MO, Fayt I, et al. Estrogen and progesterone receptors in smooth muscle component of deep infiltrating endometriosis. Fertil Steril. 2010;93(6):1774–7. Kitano T, Matsumoto T, Takeuchi H, Kikuchi I, Itoga T, Sasahara N, et al. Expression of estrogen and progesterone receptors in smooth muscle metaplasia of rectovaginal endometriosis. Int J Gynecol Pathol. 2007;26(2):124–9. Brichant G, Nervo P, Albert A, Munaut C, Foidart JM, Nisolle M. Heterogeneity of estrogen receptor alpha and progesterone receptor distribution in lesions of deep infiltrating endometriosis of untreated women or during exposure to various hormonal treatments. Gynecol Endocrinol. 2018;34(8):651–5. Vercellini P, Frattaruolo MP, Rosati R, Dridi D, Roberto A, Mosconi P, et al. Medical treatment or surgery for colorectal endometriosis? Results of a shared decision-making approach. Hum Reprod. 2018;33(2):202–11. Egekvist AG, Marinovskij E, Forman A, Kesmodel US, Graumann O, Seyer-Hansen M. Conservative treatment of rectosigmoid endometriosis: a prospective study. Acta Obstet Gynecol Scand. 2019;98(9):1139–47. Andres MP, Mendes RFP, Hernandes C, Araujo SEA, Podgaec S. Hormone treatment as first line therapy is safe and relieves pelvic pain in women with bowel endometriosis. Einstein (Sao Paulo). 2019;17(2):eAO4583. Barra F, Scala C, Ferrero S. Current understanding on pharmacokinetics, clinical efficacy and safety of progestins for treating pain associated to endometriosis. Expert Opin Drug Metab Toxicol. 2018;14(4):399–415. Fedele L, Bianchi S, Zanconato G, Portuese A, Raffaelli R. Use of a levonorgestrel-releasing intrauterine device in the treatment of rectovaginal endometriosis. Fertil Steril. 2001;75(3):485–8. Ferrero S, Camerini G, Ragni N, Venturini PL, Biscaldi E, Remorgida V. Norethisterone acetate in the treatment of colorectal endometriosis: a pilot study. Hum Reprod. 2010;25(1):94–100. Ferrero S, Leone Roberti Maggiore U, Scala C, Di Luca M, Venturini PL, Remorgida V. Changes in the size of rectovaginal endometriotic nodules infiltrating the rectum during hormonal therapies. Arch Gynecol Obstet. 2013;287(3):447–53. Leonardo-Pinto JP, Benetti-Pinto CL, Cursino K, Yela DA. Dienogest and deep infiltrating endometriosis: the remission of symptoms is not related to endometriosis nodule remission. Eur J Obstet Gynecol Reprod Biol. 2017;211:108–11. Kazama S, Hiramatsu T, Kuroda K, Hongo K, Watanabe Y, Tanaka T, et al. A case of unique endoscopic findings of intestinal endometriosis exposed to the mucosa: aggregation of papillary protruded bulges from the submucosal elevation of the rectum. Clin J Gastroenterol. 2019;12(2):166–70. Barra F, Scala C, Maggiore ULR, Ferrero S. Long-term administration of dienogest for the treatment of pain and intestinal symptoms in patients with rectosigmoid endometriosis. J Clin Med. 2020;9(1):154. Kitawaki J, Kusuki I, Yamanaka K, Suganuma I. Maintenance therapy with dienogest following gonadotropin-releasing hormone agonist treatment for endometriosis-associated pelvic pain. Eur J Obstet Gynecol Reprod Biol. 2011;157(2):212–6. Leone Roberti Maggiore U, Remorgida V, Scala C, Tafi E, Venturini PL, Ferrero S. Desogestrel-only contraceptive pill versus sequential contraceptive vaginal ring in the treatment of rectovaginal endometriosis infiltrating the rectum: a prospective open-label comparative study. Acta Obstet Gynecol Scand. 2014;93(3):239–47. Ferrari S, Persico P, Dip F, Vigano P, Tandoi I, Garavaglia E, et al. Continuous low-dose oral contraceptive in the treatment of colorectal endometriosis evaluated by rectal endoscopic ultrasonography. Acta Obstet Gynecol Scand. 2012;91(6):699–703. Markham SM, Welling DR, Larsen KS, Snell MJ. Endometriosis of the rectum treated with a long term GnRH agonist and surgery. N Y State J Med. 1991;91(2):69–71. Porpora MG, Pallante D, Ferro A, Crobu M, Cerenzia P, Panici PL. Intestinal endometriosis without evident pelvic foci treated with gonadotropin-releasing hormone agonist. Eur J Obstet Gynecol Reprod Biol. 2006;125(2):265–6. Ferrero S, Camerini G, Ragni N, Menada MV, Venturini PL, Remorgida V. Triptorelin improves intestinal symptoms among patients with colorectal endometriosis. Int J Gynaecol Obstet. 2010;108(3):250–1. Attar E, Bulun SE. Aromatase inhibitors: the next generation of therapeutics for endometriosis? Fertil Steril. 2006;85(5):1307–18. Bulun SE. Endometriosis. N Engl J Med. 2009;360(3):268–79. Ferrero S, Venturini PL, Ragni N, Camerini G, Remorgida V. Pharmacological treatment of endometriosis: experience with aromatase inhibitors. Drugs. 2009;69(8):943–52. Ferrero S, Camerini G, Ragni N, Venturini PL, Biscaldi E, Seracchioli R, et al. Letrozole and norethisterone acetate in colorectal endometriosis. Eur J Obstet Gynecol Reprod Biol. 2010;150(2):199–202. Soysal S, Soysal ME, Ozer S, Gul N, Gezgin T. The effects of post-surgical administration of goserelin plus anastrozole compared to goserelin alone in patients with severe endometriosis: a prospective randomized trial. Hum Reprod. 2004;19(1):160–7. Ferrero S, Camerini G, Venturini P, Biscaldi E, Remorgida V. Progression of bowel endometriosis during treatment with the oral contraceptive pill. Gynecol Surg. 2011;8(3):311–3. Millochau JC, Abo C, Darwish B, Huet E, Dietrich G, Roman H. Continuous amenorrhea may be insufficient to stop the progression of colorectal endometriosis. J Minim Invasive Gynecol. 2016;23(5):839–42. Roman H. Medical versus surgical treatments of rectal endometriosis (MESURE). https://www.clinicaltrials.gov/ct2/show/NCT01973816?term=endometriosis+AND+France&draw=4&rank=24. Khan KN, Fujishita A, Masumoto H, Muto H, Kitajima M, Masuzaki H, et al. Molecular detection of intrauterine microbial colonization in women with endometriosis. Eur J Obstet Gynecol Reprod Biol. 2016;199:69–75. Attar E, Yilmaz MB, Innes J, Utsunomiya H, Demura M, Bulun SE. Sodium Butyrate is a tissue specific inhibitor of aromatase expression in endometriosis. 53rd annual scientific meeting of the Society for Gynecologic Investigation, Toronto, Canada; 2006. Demura M, Bulun SE. CpG dinucleotide methylation of the CYP19 I.3/II promoter modulates cAMP-stimulated aromatase activity. Mol Cell Endocrinol. 2008;283(1–2):127–32. Grimstad FW, Decherney A. A review of the epigenetic contributions to endometriosis. Clin Obstet Gynecol. 2017;60(3):467–76. Kamergorodsky G, Invitti AL, D'Amora P, Parreira RM, Kopelman A, Bonetti TCS, et al. Progesterone’s role in deep infiltrating endometriosis: progesterone receptor and estrogen metabolism enzymes expression and physiological changes in primary endometrial stromal cell culture. Mol Cell Endocrinol. 2020;505:110743. Bulun SE, Cheng YH, Yin P, Imir G, Utsunomiya H, Attar E, et al. Progesterone resistance in endometriosis: link to failure to metabolize estradiol. Mol Cell Endocrinol. 2006;248(1–2):94–103. Pavone ME, Malpani SS, Dyson M, Kim JJ, Bulun SE. Fenretinide: a potential treatment for endometriosis. Reprod Sci. 2016;23(9):1139–47. Barra F, Scala C, Biscaldi E, Vellone VG, Ceccaroni M, Terrone C, et al. Ureteral endometriosis: a systematic review of epidemiology, pathogenesis, diagnosis, treatment, risk of malignant transformation and fertility. Hum Reprod Update. 2018;24(6):710–30. Ferrero S, Remorgida V, Venturini PL. Current pharmacotherapy for endometriosis. Expert Opin Pharmacother. 2010;11(7):1123–34. Author information Authors and Affiliations Editor information Editors and Affiliations Rights and permissions Copyright information © 2020 Springer Nature Switzerland AG About this chapter Cite this chapter Ferrero, S., Barra, F., Loddo, A., Attar, E. (2020). Hormonal Treatment of Bowel Endometriosis. In: Ferrero, S., Ceccaroni, M. (eds) Clinical Management of Bowel Endometriosis. Springer, Cham. https://doi.org/10.1007/978-3-030-50446-5_16 Download citation DOI: https://doi.org/10.1007/978-3-030-50446-5_16 Published: Publisher Name: Springer, Cham Print ISBN: 978-3-030-50445-8 Online ISBN: 978-3-030-50446-5 eBook Packages: MedicineMedicine (R0)