Long-Term Administration of Dienogest for the Treatment of Pain and Intestinal Symptoms in Patients with Rectosigmoid Endometriosis

Abstract

Background: Rectosigmoid endometriosis is a severe form of deep endometriosis, which may be responsible for pain symptoms and a wide range of intestinal complains such as diarrhea, constipation, and abdominal cramping. The primary objective of this study was to evaluate the efficacy of long-term therapy with dienogest (DNG), a fourth-generation progestin, for ameliorating quality of life, pain, and intestinal symptoms of patients affected by rectosigmoid endometriosis. Methods: A retrospective analysis of a prospectively collected database was done on patients with endometriotic nodules infiltrating at least the muscular layer of the rectosigmoid wall with an estimated colorectal stenosis <60%. The diagnosis of rectosigmoid endometriosis was based on transvaginal ultrasonography. Patients accepting to participate in the study received continuous oral treatment with DNG at the dose of 2 mg/day. Results: At the end of the first year of treatment, a significant decrease in dysmenorrhea (P < 0.001), chronic pelvic pain (P < 0.001), dyspareunia (P < 0.001), dyschezia (P < 0.001), and in intestinal symptoms (P < 0.001) was observed. A progressive increase of the Endometriosis Health Profile-30 (EHP-30) and Gastrointestinal Quality of Life Index (GIQLI) scores was observed in the first two years of therapy (P < 0.001 and P < 0.001, respectively). Improvements of patients’ symptoms and quality of life were maintained until the end of the study. The regimen was well tolerated, and the frequency and amount of irregular bleeding decreased as treatment progressed. Conclusion: The current study confirms the efficacy of long-term therapy with DNG for treating symptoms caused by rectosigmoid endometriosis.

To evaluate the effectiveness of dienogest in controlling bleeding abnormalities in endometriosis

“…In our examination 24% were having endometriosis. Then again Techatraisak K et al [7] (2019) all patients 864/864 100% patients had history of endometriosis. In the examination Caruso S. et al [8] (2018) most normal manifestation was constant pelvic torment in 100% (n=51) ladies, dysmenorrhea n=50 (78.4%) and Dyspareunia n=38 (74.5%).…”

Advances in the medical management of bowel endometriosis

“…On the other hand, Egekvist et al [29] observed that progression of nodule volume dimensions occurred without worsening of symptoms or healthrelated quality of life. Barra et al [33] also confirmed that the increase in endometriotic nodule volume during dienogest therapy was not always associated with worsening of clinical symptoms.…”

“…Barra et al [33] [32] reported persistence of pain symptoms in the vast majority of women in whom the nodule regressed or remained stable. On the other hand, Egekvist et al [29] observed that progression of nodule volume dimensions occurred without worsening of symptoms or healthrelated quality of life.…”

“…Bowel lesions, especially when infiltrating the sigmoid colon and the rectosigmoid junction, should be checked periodically with imaging techniques [15,16], with the aim of identifying nodule progression during progestogen treatment despite partial or complete symptom relief [33].…”

“…Higher satisfaction with treatment in NETA group. (33) Mood swings (33) Weakness (25) Bone and joint pain (25) Significant Vaginal spotting (17) Muscle aches (17) Headache (17) Depression (17) Hot flushes (8) Nausea 8Decreased libido (8) scores Weight gain (20) Joint pain (17) Myalgia (12) Spotting (10) Breakthrough bleeding Weight gain >3 kg (13) Vaginal irritation (13) satisfaction rate with the treatment (80% of women were satisfied or very satisfied). Decreased libido (12) Spotting 12Myalgia and arthralgia (12) Depression (6) Triptorelin group:…”