RESUMEN
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 E2, 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.
Asunto(s)
Endometriosis/tratamiento farmacológico , Terapia de Reemplazo de Estrógeno/métodos , Estrógenos/administración & dosificación , Noretindrona/análogos & derivados , Progestinas/administración & dosificación , Enfermedades del Recto/tratamiento farmacológico , Enfermedades Vaginales/tratamiento farmacológico , Adolescente , Adulto , Intervalos de Confianza , Quimioterapia Combinada , Endometriosis/patología , Femenino , Humanos , Persona de Mediana Edad , Noretindrona/administración & dosificación , Acetato de Noretindrona , Dimensión del Dolor/efectos de los fármacos , Enfermedades del Recto/patología , Estadísticas no Paramétricas , Enfermedades Vaginales/patologíaRESUMEN
BACKGROUND: It has been suggested recently that deep endometriosis and the other forms of the disease do not share a common pathogenetic mechanism. In this study, we hypothesize that, if this is true, deep peritoneal endometriosis and the other forms should not be significantly associated. METHODS: Clinical and surgical records of all women who were referred to the Department of Obstetrics and Gynecology, Clinica 'L.Mangiagalli' between January 1995 and June 2002 and who were diagnosed with deep peritoneal pelvic endometriosis at the time of surgery were retrieved. The concomitant presence of superficial endometriotic implants, endometriomas and pelvic adhesions was evaluated. A binomial probability distribution model was used to calculate the 95% confidence interval (95% CI) of the association rates. RESULTS: Ninety-three women with deep peritoneal endometriosis were identified. The presence of superficial endometriotic implants, endometriomas and pelvic adhesions was documented in 61.3% (95% CI 51.4-71.2%), 50.5% (95% CI 40.3-60.7%) and 74.2% (95% CI 65.3-83.1%) of patients with deep endometriotic nodules, respectively. Overall, deep peritoneal endometriosis was the only form of the disease in only 6.5% (95% CI 2.8-12.3%) of cases. No relevant differences regarding these associations were observed according to the location and the size of the deep endometriotic nodules. CONCLUSIONS: Results from this study do not support the hypothesis that deep endometriosis should be considered as a distinct entity of the disease.
Asunto(s)
Enfermedades de los Anexos/etiología , Endometriosis/complicaciones , Endometriosis/patología , Enfermedades Peritoneales/complicaciones , Enfermedades Peritoneales/patología , Adherencias Tisulares/etiología , Enfermedades de los Anexos/epidemiología , Adulto , Intervalos de Confianza , Quistes/epidemiología , Quistes/etiología , Femenino , Humanos , Incidencia , Enfermedades del Ovario/epidemiología , Enfermedades del Ovario/etiología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Adherencias Tisulares/epidemiologíaRESUMEN
Endometriosis is an estrogen-dependent disorder mostly occurring in reproductive-age women. Various therapies have been used in an attempt to treat endometriosis, including ovarian suppression therapy, surgical treatment or a combination of these strategies. However, in general, substantial surgery remains the primary treatment option for endometriosis at all stages. Recently, aromatase inhibitors and anti-estrogens have been proposed as novel potential candidates. The rationale for the use of aromatase inhibitors is mostly related to the high aromatase expression in endometriotic cysts and extra-ovarian endometriotic implants. Among anti-estrogens, raloxifene has been investigated in animal models with good results, but in premenopausal women, the compound does not seem to suppress estrogen production.