Efficacy of pharmacotherapy in patients with deep endometriosis and chronic pelvic pain syndrome

Objective. To study the efficacy of dienogest in the conservative management of patients with deep endometriosis (DE) and chronic pelvic pain syndrome (CPPS). Patients and methods. The study included 25 reproductive-aged patients (Me = 33.5 years) with DE and CPPS who had not undergone surgical treatment for endometriosis. Complaints, quality of life (Medical Outcomes Study-Short form, MOS SF-36), pelvic examination and pelvic ultrasound before and after therapy with dienogest 2 mg (Zafrilla) considering ENZIAN (U) classification were evaluated. Treatment efficacy was assessed at 3 and 6 months after continuous medication use. Results. Patients with DE and CPPS presented the following common complaints: dysmenorrhea (80% of women) and dyspareunia (72%), and one in two patients (56%) had flatulence during menstruation (p < 0.05). This category of patients showed a significant decrease in the quality of life according to all 8 transformed scales, which amounted to 40–69% (p < 0.05). A 6-month therapy with Zafrilla statistically significantly reduced the intensity of pain by 55.5%, improved the quality of life by more than 2 times, which is due to a 44.4% decrease in the number of complaints of dyspareunia (p < 0.05). Moreover, there was a decrease in the volume of endometriotic lesions and depth of invasion from 12 to 36% according to ultrasound and the new ENZIAN (U) classification, p < 0.05. Conclusion. Conservative therapy for DE with dienogest 2 mg in a continuous regimen improves the quality of life of women by more than 2 times, which is due to a decrease in the intensity and frequency of pain in patients with CPPS (p < 0.05). Key words: dienogest, deep endometriosis, chronic pelvic pain syndrome, ENZIAN (U) classification