Continuous low‐dose oral contraceptive in the treatment of colorectal endometriosis evaluated by rectal endoscopic ultrasonography

Ferrari S, Stefano Ferrari, Persico P, Paola Persico, Di Puppo F, Francesca DI Puppo, Francesca Puppo, Paola Viganò, Paola Vigano, Tandoi I, Iacopo Tandoi, Garavaglia E, Elisabetta Garavaglia, Paolo Giardina, Giardina P, Mezzi G, Gianni Mezzi, G. Mezzi, Massimo Candiani
Acta obstetricia et gynecologica Scandinavica · 2012 · vol. 91(6) , pp. 699–703 · doi:10.1111/j.1600-0412.2012.01366.x · PMID:22268632 · W1491539436
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Continuous low-dose oral contraceptive therapy for 12 months reduced pain symptoms and significantly decreased the diameter and volume of colorectal endometriotic nodules as assessed by rectal endoscopic ultrasonography.

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Abstract

OBJECTIVE: Limited attention has been focused on the medical treatment of bowel endometriosis. This study evaluates the efficacy of administration of a continuous low-dose oral contraceptive in treating pain and other symptoms associated with colorectal endometriotic nodules, as evaluated by rectal endoscopic ultrasonography. DESIGN: Prospective observational study. SETTING: Academic Department of San Raffaele Scientific Institute, Obstetrics and Gynecology Unit. POPULATION: Symptomatic women of reproductive age (n=26) with colorectal nodules infiltrating at least the bowel muscularis propria and without a stenosis >50%. In 31% of the patients, endoscopic ultrasonography permitted diagnosis of nodules located more than 10 cm from the anal rim. METHODS: Patients received a continuous low-dose oral contraceptive containing 15 μg ethinylestradiol and 60 μg gestodene for 12 months. Subjective symptoms were prospectively evaluated, and nodule volumes were monitored using endoscopic ultrasonography. MAIN OUTCOME MEASURES: Nodule measurements were performed at baseline and after 12 months of treatment. Symptoms at the start and after 12 months were evaluated. RESULTS: A significant improvement in the intensity of all the considered symptoms (dysmenorrhea, non-menstrual pelvic pain, deep dyspareunia and painful defecation) was seen when evaluated by a visual analog scale. A reduction in terms of both diameter (mean reduction 26%) and volume of the nodules (mean reduction 62%) was observed after a 12 month period. CONCLUSIONS: A continuous low-dose oral contraceptive therapy may reduce bowel endometriosis-associated symptoms. In addition, this therapy induces a significant volumetric reduction of colorectal plaques when evaluated by endoscopic ultrasonography.

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Condition tags

dysmenorrheadyspareuniaendometriosischronic_pelvic_painbowel_endometriosis

MeSH descriptors

Colonic Diseases Contraceptives, Oral, Synthetic Endometriosis Rectal Diseases Adult Colonic Diseases Colonic Diseases Contraceptives, Oral, Synthetic Dose-Response Relationship, Drug Drug Combinations Dysmenorrhea Dysmenorrhea Dysmenorrhea Dyspareunia Dyspareunia Dyspareunia Endometriosis Endometriosis Endosonography Ethinyl Estradiol

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