Treatment of symptomatic rectovaginal endometriosis with an estrogen–progestogen combination versus low-dose norethindrone acetate

Paolo Vercellini, Pietropaolo G, Giuliana Pietropaolo, Olga De Giorgi, Roberta Pasin, Pasin R, Annalisa Chiodini, Chiodini A, Pier Giorgio Crosignani, Crosignani PG
Fertility and sterility · 2005 · vol. 84(5) , pp. 1375–1387 · doi:10.1016/j.fertnstert.2005.03.083 · PMID:16275232 · W2062896185
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This study compared the efficacy of an estrogen–progestogen combination versus low-dose norethindrone acetate in treating symptomatic rectovaginal endometriosis.

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Abstract

ObjectiveTo evaluate the efficacy, safety, and tolerability of an estrogen-progestogen combination versus low-dose norethindrone acetate in the treatment of persistent pain after surgery for symptomatic rectovaginal endometriosis.DesignRandomized controlled trial.SettingAcademic center.Patient(s)Ninety women with recurrent moderate or severe pelvic pain after unsuccessful conservative surgery for symptomatic rectovaginal endometriosis.Intervention(s)Twelve-month, continuous treatment with oral ethinyl E2, 0.01 mg, plus cyproterone acetate, 3 mg/day, or norethindrone acetate, 2.5 mg/day.Main outcome measure(s)Degree of satisfaction with therapy.Result(s)Seven women in the ethinyl E2 plus cyproterone acetate arm and five in the norethindrone acetate arm withdrew because of side effects (n=5), treatment inefficacy (n=6), or loss to follow-up (n=1). At 12 months, dysmenorrhea, deep dyspareunia, nonmenstrual pelvic pain, and dyschezia scores were substantially reduced without major between-group differences. Both regimens induced minor unfavorable variations in the serum lipid profile. According to an intention-to-treat analysis, 28 (62%) out of 45 patients in the ethinyl E2 plus cyproterone acetate group and 33 (73%) out of 45 in the norethindrone acetate group were satisfied with the treatment received.Conclusion(s)Low-dose norethindrone acetate could be considered an effective, tolerable, and inexpensive first-choice medical alternative to repeat surgery for treating symptomatic rectovaginal endometriotic lesions in patients who do not seek conception.

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Condition tags

endometriosisbowel_endometriosis

MeSH descriptors

Endometriosis Estrogen Replacement Therapy Estrogens Norethindrone Progestins Rectal Diseases Vaginal Diseases Adolescent Adult Confidence Intervals Drug Therapy, Combination Endometriosis Endometriosis Estrogen Replacement Therapy Estrogens Female Humans Middle Aged Norethindrone Norethindrone

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