Desogestrel only contraceptive pill versus sequential contraceptive vaginal ring in the treatment of rectovaginal endometriosis infiltrating the rectum: a prospective open-label comparative study
About: This article is published in Fertility and Sterility.The article was published on 2013-09-01. It has received 24 citations till now. The article focuses on the topics: Vaginal ring & Desogestrel.
Citations
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TL;DR: Few studies of medical therapies for endometriosis report outcomes that are relevant to patients, and many women gain only limited or intermittent benefit from treatment.
140 citations
Cites background or methods from "Desogestrel only contraceptive pill..."
...These studies showed that a median of 43% of women who received CHCs (range 36%–71%, four treatment arms) (43, 45, 50) and a median of 62% of women who received a progestin (range 59%–72%, five treatment arms) (43, 45, 46, 47) were satisfied with their treatment....
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...Patient-reported ratings of treatment satisfaction considering overall well-being and quality of life, any adverse effects experienced, and convenience of treatment were evaluated in only five studies (43, 45, 46, 47, 50)....
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...5 cm, two treatment arms) after 12 months (30, 43)....
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...Patient-reported VAS data were available from six studies (30, 34, 39, 42, 43, 48); an additional four articles (40, 44–46)...
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...1 cm, four treatment arms) after treatment for 12 months (30, 43)....
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TL;DR: Current evidence does not support the removal of bladder endometriotic lesions because of the potential risk of malignant transformation since this phenomenon is exceedingly rare, and the review provides a useful tool to guide physicians in the management of this complex condition.
110 citations
TL;DR: Surgical excision of DIE should be considered in patients with pain symptoms persisting after first-line hormonal therapies, and the benefits of surgery in terms of pain improvement should be always balanced with the risk of intraoperative complications.
102 citations
Cites background or result from "Desogestrel only contraceptive pill..."
...Both hormonal therapies were efficacious in treating pain and gastrointestinal symptoms; patient satisfaction was higher with the DSG-only pill than with the vaginal ring (103)....
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...When compared with baseline values, the intensity of chronic pelvic pain and dyspareunia were significantly decreased at 3mo and 6mo in both groups, whereas the intensity of dyschezia decreased only at 6 mo Leone Roberti Maggiore (103), 2014 Italy Patients preference trial 60 34....
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...The role of E-progestin combinations to treat endometriosis-associated pain has been also investigated using formulationsdelivered in alternativeways (103, 121)....
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...Desogestrel (DSG)only formulations have been tested to treat women with DIE (86, 103, 104)....
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...0%) Vaginal ring and transdermal patch (103, 121) Weight increase (5%–7%); headache (6%–18%); vomiting (2%); nausea (2%–8%); depression (5%–6%); libido decrease (4%–5%); breast pain, tenderness (5%–8%); cutaneous reactions (5%); bloating (3%–10%); vaginal dryness (2%–7%); irregular bleeding (2....
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TL;DR: A stepwise approach is suggested, starting with OCs or low-cost progestogens, and stepping up to high-cost drugs only in case of inefficacy or intolerance, as the individual response to different drugs is variable.
Abstract: Available medical treatments for symptomatic endometriosis act by inhibiting ovulation, reducing serum oestradiol levels, and suppressing uterine blood flows. For this, several drugs can be used with a similar magnitude of effect, in terms of pain relief, independently of the mechanism of action. Conversely, safety, tolerability, and cost differ. Medications for endometriosis can be categorized into low-cost drugs including oral contraceptives (OCs) and most progestogens, and high-cost drugs including dienogest and GnRH agonists. As the individual response to different drugs is variable, a stepwise approach is suggested, starting with OCs or low-cost progestogens, and stepping up to high-cost drugs only in case of inefficacy or intolerance. OCs may be used in women with dysmenorrhea as their main complaint, and when only superficial peritoneal implants or ovarian endometriomas
98 citations
TL;DR: Women on DNG/EE COC continuous regimen reported a reduction of endometriosis-associated pelvic pain and there was an improvement of their sexual activity and their QoL that was better than the D NG/EE 21/7 conventional regimen.
Abstract: To evaluate the effects of a continuous regimen combined oral contraceptive (COC) containing 2 mg dienogest and 30 µg ethinyl estradiol (DNG/EE) compared to a 21/7 regimen on the quality of life (QoL) and sexual function in women affected by endometriosis-associated pelvic pain.
Sixty-three women constituted the Study group treated with DNG/EE COC continuous regimen; 33 women were given DNG/EE COC in a 21/7 regimen. To define the endometriosis-associated pelvic pain, the Visual Analogic Scale was used. The Short Form-36, Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS) were used to assess QoL, sexual function and sexual distress, respectively. The study included two follow-ups. At 3 and 6 months of treatment there was an improvement in pain of the Study group (p < 0.001). The Control group underwent pain improvement at the second follow-up (p < 0.05). At the first and the second follow-ups, the Study group reported QoL improvements in all categories (p < 0.001). The Control group reported QoL improvements in all categories at the second follow-up (p < 0.05). At the first and the second follow-ups of the Study group, the FSFI total score had risen (p < 0.001), and the FSDS score had dropped (p < 0.001). An improvement of the FSFI score and a reduction of the FSDS score of the Control group was observed at the second follow-up (p < 0.001), but not at the first follow-up (p = NS). Women on DNG/EE COC continuous regimen reported a reduction of endometriosis-associated pelvic pain and there was an improvement of their sexual activity and their QoL that was better than the DNG/EE 21/7 conventional regimen.
62 citations
Additional excerpts
...1 3 endometriosis-related pain symptoms [12, 13]....
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References
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TL;DR: Few studies of medical therapies for endometriosis report outcomes that are relevant to patients, and many women gain only limited or intermittent benefit from treatment.
140 citations
TL;DR: Current evidence does not support the removal of bladder endometriotic lesions because of the potential risk of malignant transformation since this phenomenon is exceedingly rare, and the review provides a useful tool to guide physicians in the management of this complex condition.
110 citations
TL;DR: Surgical excision of DIE should be considered in patients with pain symptoms persisting after first-line hormonal therapies, and the benefits of surgery in terms of pain improvement should be always balanced with the risk of intraoperative complications.
102 citations
TL;DR: A stepwise approach is suggested, starting with OCs or low-cost progestogens, and stepping up to high-cost drugs only in case of inefficacy or intolerance, as the individual response to different drugs is variable.
Abstract: Available medical treatments for symptomatic endometriosis act by inhibiting ovulation, reducing serum oestradiol levels, and suppressing uterine blood flows. For this, several drugs can be used with a similar magnitude of effect, in terms of pain relief, independently of the mechanism of action. Conversely, safety, tolerability, and cost differ. Medications for endometriosis can be categorized into low-cost drugs including oral contraceptives (OCs) and most progestogens, and high-cost drugs including dienogest and GnRH agonists. As the individual response to different drugs is variable, a stepwise approach is suggested, starting with OCs or low-cost progestogens, and stepping up to high-cost drugs only in case of inefficacy or intolerance. OCs may be used in women with dysmenorrhea as their main complaint, and when only superficial peritoneal implants or ovarian endometriomas
98 citations
TL;DR: Women on DNG/EE COC continuous regimen reported a reduction of endometriosis-associated pelvic pain and there was an improvement of their sexual activity and their QoL that was better than the D NG/EE 21/7 conventional regimen.
Abstract: To evaluate the effects of a continuous regimen combined oral contraceptive (COC) containing 2 mg dienogest and 30 µg ethinyl estradiol (DNG/EE) compared to a 21/7 regimen on the quality of life (QoL) and sexual function in women affected by endometriosis-associated pelvic pain.
Sixty-three women constituted the Study group treated with DNG/EE COC continuous regimen; 33 women were given DNG/EE COC in a 21/7 regimen. To define the endometriosis-associated pelvic pain, the Visual Analogic Scale was used. The Short Form-36, Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS) were used to assess QoL, sexual function and sexual distress, respectively. The study included two follow-ups. At 3 and 6 months of treatment there was an improvement in pain of the Study group (p < 0.001). The Control group underwent pain improvement at the second follow-up (p < 0.05). At the first and the second follow-ups, the Study group reported QoL improvements in all categories (p < 0.001). The Control group reported QoL improvements in all categories at the second follow-up (p < 0.05). At the first and the second follow-ups of the Study group, the FSFI total score had risen (p < 0.001), and the FSDS score had dropped (p < 0.001). An improvement of the FSFI score and a reduction of the FSDS score of the Control group was observed at the second follow-up (p < 0.001), but not at the first follow-up (p = NS). Women on DNG/EE COC continuous regimen reported a reduction of endometriosis-associated pelvic pain and there was an improvement of their sexual activity and their QoL that was better than the DNG/EE 21/7 conventional regimen.
62 citations