Role of medical therapy in the management of deep rectovaginal endometriosis

Paolo Vercellini, Buggio L, Laura Buggio, Edgardo Somigliana, Somigliana E
Fertility and sterility · 2017 · vol. 108(6) , pp. 913–930 · doi:10.1016/j.fertnstert.2017.08.038 · PMID:29202965 · W2773939391
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This paper reviews the current role of medical therapies, including hormonal and non-hormonal agents, in managing deep rectovaginal endometriosis.

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Abstract

Defining whether medical therapy is effective in women with deep rectovaginal endometriosis and in which circumstances it can be considered an alternative to surgery is important for patients and physicians. Numerous observational and some randomized controlled studies demonstrated that different hormonal drugs improved pain and other symptoms in approximately two-thirds of women with deep rectovaginal endometriosis. Because major differences in the effect size of various compounds were not observed, much importance should be given to safety, tolerability, and cost of medications when counseling patients. Progestins seem to offer the best therapeutic balance when long-term treatments are planned. Women should be informed that hormonal drugs control but do not cure endometriosis and that, to avoid surgery, they should be used for years. Medical therapy is not an alternative to surgery in women with hydronephrosis, severe subocclusive bowel symptoms, and in those wishing a natural conception. A progestin should systematically be chosen as a comparator in future randomized trials on novel medications for deep endometriosis. In the meantime, the use of existing drugs should be optimized, and medical and surgical treatments could be viewed as subsequent stages of a stepwise approach. In general, there is no absolute "best" choice, and women must be thoroughly informed of potential benefits, potential harms, and costs of different therapeutic options and allowed to choose what they deem is better for them.

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Condition tags

endometriosisbowel_endometriosis

MeSH descriptors

Endometriosis Endometrium Hormones Rectal Diseases Vaginal Diseases Animals Biopsy Colposcopy Endometriosis Endometriosis Endometriosis Endometriosis Endometrium Endometrium Endometrium Estrogens Estrogens Female Hormones Hormones

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (98)

Cited by (47)

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