Hormone treatment as first line therapy is safe and relieves pelvic pain in women with bowel endometriosis

Abstract

Objective: To evaluate clinical features and complications in patients with bowel endometriosis submitted to hormonal therapy. Methods: Retrospective study based on data extracted from medical records of 238 women with recto-sigmoid endometriosis treated between May 2010 and May 2016. Results: Over the course of follow-up, 143 (60.1%) women remained in medical treatment while 95 (39.9%) presented with worsening of pain symptoms or intestinal lesion growth (failure of medical treatment group), with surgical resection performed in 54 cases. Women in the Medical Treatment Group were older (40.5±5.1 years versus 37.3±5.8 years; p<0.0001) and had smaller recto sigmoid lesions (2.1±1.9 versus 3.1±2.2; p=0.008) compared to those who had failed to respond to medical treatment. Similar significant reduction in pain scores for dysmenorrhea, chronic pelvic pain, cyclic dyschezia and dysuria was observed in both groups; however greater reduction in pain scores for dyspareunia was noted in the Surgical Group. Subjective improvement in pain symptoms was also similar between groups (100% versus 98.2%; p=0.18). Major complications rates were higher in the Surgical Group (9.2% versus 0.6%; p=0.001). Conclusion: Patients with recto-sigmoid endometriosis who failed to respond to medical treatment were younger and had larger intestinal lesions. Hormonal therapy was equally efficient in improving pain symptoms other than dyspareunia compared to surgery, and was associated with lower complication rates in women with recto-sigmoid endometriosis. Medical treatment should be offered as a first-line therapy for patients with bowel endometriosis. Surgical treatment should be reserved for patients with pain symptoms unresponsive to hormonal therapy, lesion growth or suspected intestinal subocclusion.

Incidência De Possíveis Portadores De Transtorno De Déficit De Atenção/ Hiperatividade (Tdah) Em Acadêmicos De Medicina

“…Em mulheres com diagnóstico de endometriose, costuma-se recomendar como terapia de primeira linha o uso de progestogênios e contraceptivos combinados devido à alta eficácia e singulares efeitos adversos (ANDRES et al, 2019).…”

Advances in the medical management of bowel endometriosis

“…Only one case of sub-acute bowel obstruction in a woman with rectosigmoid junction endometriosis was described in the 33 studies considered in this review [34]. The type of medication used was not reported.…”

“…A total of 123 women (21%) underwent surgery during the study period (persistence or worsening of pain symptoms, n=79; lesion size progression, n=26; intolerance of medical treatment, n=11; indication not reported, n=6; occlusive symptoms, n=1). Of note, 95 out of these 123 women were described in a single study [34]. Excluding this outlier, the probability of undergoing surgery Vercellini et al,9 despite medical therapy was 8% (28/350; persistence or worsening of pain symptoms, n=11;…”

“…In the considered period, a total of 588 patients were included in 10 studies (prospective cohort, n=5; retrospective cohort, n=5; Table 2). However, 238 participants were enrolled in a single study [34]. The experimental study drug was a progestin in 3 studies, an OPC in 1, an aromatase inhibitor in 1, a GnRH agonist in 1, and multiple hormonal drugs in 4.…”

Clinical Treatment of Deep Infiltrating Endometriosis – Impacts on Sexual Function

“…Nuclear magnetic resonance and ultrasound imaging with intestinal preparation may presume a diagnosis of deep infiltrating endometriosis, although the definitive diagnosis of the disease is histopathological [15].…”