Role of medical therapy in the management of deep rectovaginal endometriosis

Research output: Contribution to journalReview articlepeer-review

Abstract

Defining whether medical therapy is effective in women with deep rectovaginal endometriosis and in which circumstances it can be considered an alternative to surgery is important for patients and physicians. Numerous observational and some randomized controlled studies demonstrated that different hormonal drugs improved pain and other symptoms in approximately two-thirds of women with deep rectovaginal endometriosis. Because major differences in the effect size of various compounds were not observed, much importance should be given to safety, tolerability, and cost of medications when counseling patients. Progestins seem to offer the best therapeutic balance when long-term treatments are planned. Women should be informed that hormonal drugs control but do not cure endometriosis and that, to avoid surgery, they should be used for years. Medical therapy is not an alternative to surgery in women with hydronephrosis, severe subocclusive bowel symptoms, and in those wishing a natural conception. A progestin should systematically be chosen as a comparator in future randomized trials on novel medications for deep endometriosis. In the meantime, the use of existing drugs should be optimized, and medical and surgical treatments could be viewed as subsequent stages of a stepwise approach. In general, there is no absolute “best” choice, and women must be thoroughly informed of potential benefits, potential harms, and costs of different therapeutic options and allowed to choose what they deem is better for them.

Original languageEnglish
Pages (from-to)913-930
Number of pages18
JournalFertility and Sterility
Volume108
Issue number6
DOIs
Publication statusPublished - Dec 1 2017

Keywords

  • Dysmenorrhea
  • dyspareunia
  • endometriosis
  • medical therapy
  • pelvic pain

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynaecology

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