Daily Vaginal Application of Dienogest (Visanne©) for 3 Months in Symptomatic Deeply Infiltrating Rectovaginal Endometriosis: A Possible New Treatment Approach?

Abstract

A 27-year-old patient suffering from deeply infiltrating rectovaginal endometriosis was treated with 2 mg/day dienogest vaginally for 3 months. The therapy was tolerated very well. The patient reported less side effects compared to the oral use of dienogest. After 3 months of dienogest treatment, the rectovaginal gynecological examination identified the visible vaginal part of endometriosis in remission. The firm endometriosis node approximately 3 cm in size and approximately 10 cm ab ano was still palpable, but it was much less painful. The laboratory values for luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were unremarkable, with an LH/FSH quotient of 0.7 during dienogest treatment, while 17-β estradiol and progesterone were suppressed. At palpation and vaginal ultrasonography, there was no change in the findings before and after 3 months of dienogest treatment, but the patient was now de facto asymptomatic. To the best of our knowledge, this is the first report of a vaginal dienogest treatment in symptomatic deeply infiltrating rectovaginal endometriosis. Vaginal administration of dienogest should receive further investigation in pharmacokinetic and clinical studies.

The Impact of Ulipristal Acetate (UPA) versus Dienogest on Pain Related to Endometriomas Evaluated with Visual Analogue Scale (VAS)

“…Dienogest is efficient and safe for management of endometriosis associated pelvic pain [23] and avoidpain recurrence post surger y. Dienogest is well tolerated and side effects can be clinically managed [24]. Vaginal treatment with dienogest is innovative for symptomatic deeply infiltrating rectovaginal endometriosisand should receive further investigation in pharmacokinetic and clinical studies [25]. On the ovary, Duphaston and Dienogest are effective progestins that can be used as oral contraceptivewith different ovulation inhibitory effects [26,27].…”

Impact of 1.0 mg/Day Dienogest Treatment on Bone Metabolism Markers in Young Women with Dysmenorrhea

“…The oral contraceptive pill (OCP) is recognized as the first-line treatment for dysmenorrhea in adolescent women, and progestin may also be a good option when dysmenorrhea is associated with endometriosis or severe PMS [12]. A previous study has reported that DNG 2 mg/day had no effect on follicle-stimulating hormone (FSH) or luteinizing hormone (LH) secretion, and that 17β-estradiol showed a slight decrease (68 pg/mL) after 6 months [13,14]. However, no study has investigated the effect on gonadotropin levels of an even lower dose of DNG of 1 mg/day.…”