Treatment of symptomatic rectovaginal endometriosis with an estrogen-progestogen combination versus low-dose norethindrone acetate

Paolo Vercellini, Giuliana Pietropaolo, Olga De Giorgi, Roberta Pasin, Annalisa Chiodini, Pier Giorgio Crosignani

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To evaluate the efficacy, safety, and tolerability of an estrogen-progestogen combination versus low-dose norethindrone acetate in the treatment of persistent pain after surgery for symptomatic rectovaginal endometriosis. Design: Randomized controlled trial. Setting: Academic center. Patient(s): Ninety women with recurrent moderate or severe pelvic pain after unsuccessful conservative surgery for symptomatic rectovaginal endometriosis. Intervention(s): Twelve-month, continuous treatment with oral ethinyl E 2, 0.01 mg, plus cyproterone acetate, 3 mg/day, or norethindrone acetate, 2.5 mg/day. Main Outcome Measure(s): Degree of satisfaction with therapy. Result(s): Seven women in the ethinyl E2 plus cyproterone acetate arm and five in the norethindrone acetate arm withdrew because of side effects (n=5), treatment inefficacy (n=6), or loss to follow-up (n=1). At 12 months, dysmenorrhea, deep dyspareunia, nonmenstrual pelvic pain, and dyschezia scores were substantially reduced without major between-group differences. Both regimens induced minor unfavorable variations in the serum lipid profile. According to an intention-to-treat analysis, 28 (62%) out of 45 patients in the ethinyl E2 plus cyproterone acetate group and 33 (73%) out of 45 in the norethindrone acetate group were satisfied with the treatment received. Conclusion(s): Low-dose norethindrone acetate could be considered an effective, tolerable, and inexpensive first-choice medical alternative to repeat surgery for treating symptomatic rectovaginal endometriotic lesions in patients who do not seek conception.

Original languageEnglish
Pages (from-to)1375-1387
Number of pages13
JournalFertility and Sterility
Volume84
Issue number5
DOIs
Publication statusPublished - Nov 2005

Keywords

  • Dysmenorrhea
  • Dyspareunia
  • Endometriosis
  • Estrogen-progestogen combination
  • Medical treatment
  • Pelvic pain
  • Progestogen

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

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