“Per vaginam” topical use of hormonal drugs in women with symptomatic deep endometriosis: a narrative literature review

Purpose We aim to provide a comprehensive overview of the role of the vagina as a route for drug delivery and absorption, with a particular focus on the use of vaginal hormonal compounds for the treatment of deep infiltrating symptomatic endometriosis.

A MEDLINE search through PubMed was performed to identify all published studies in English language on vaginal hormonal treatments for symptomatic endometriosis.

Main advantages of the vaginal route include avoidance of the hepatic-first pass metabolic effect, the possibility of using lower therapeutic dosages, and the reduction of side effects compared with the oral administration. Studies on endometriosis treatment mainly focused on the use of vaginal danazol (n = 6) and the contraceptive vaginal ring (n = 2). One pilot study evaluated the efficacy of vaginal anastrozole in women with rectovaginal endometriosis. Most investigations evaluated the vaginal use of hormonal agents in women with deep infiltrating endometriosis/rectovaginal endometriosis. Overall, a substantial amelioration of pelvic pain symptoms associated with endometriosis was observed, particularly of dysmenorrhea. A significant reduction in rectovaginal endometriotic nodule dimensions measured at ultrasound examination was detected by some but not all authors.

The vaginal route represents a scarcely explored modality for drug administration. High local hormonal concentrations might achieve a greater effect on endometriotic lesions compared with alternative routes. Future studies should focus on the use of the vagina for delivering target therapies particularly in patients with deeply infiltrating rectovaginal lesions. Similar content being viewed by others

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Arch Gynecol Obstet 284:105–110. doi:10.1007/s00404-010-1599-6 Author information Authors and Affiliations Contributions LB: Project development, Data collection, Manuscript writing/editing. CL: Data collection, Manuscript editing. EM: Data collection. GB: Data collection, Manuscript editing. NB: Data collection. PV: Project development, Manuscript writing/editing. Corresponding author Ethics declarations Funding This article was financed by Italian fiscal contribution “5x1000”—Ministero dell’Istruzione, dell’Università e della Ricerca—devolved to Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy. Conflict of interest All authors declare that have no conflict of interest. Ethical approval This article does not contain any studies with human participants or animal performed by any of the authors. Rights and permissions About this article Cite this article Buggio, L., Lazzari, C., Monti, E. et al. “Per vaginam” topical use of hormonal drugs in women with symptomatic deep endometriosis: a narrative literature review. Arch Gynecol Obstet 296, 435–444 (2017). https://doi.org/10.1007/s00404-017-4448-z Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00404-017-4448-z