title: Treatment of symptomatic rectovaginal endometriosis with an estrogen-progestogen combination versus low-dose norethindrone acetate.
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.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Academic center.
  
  
  METHODS
  Ninety women with recurrent moderate or severe pelvic pain after unsuccessful conservative surgery for symptomatic rectovaginal endometriosis.
  
  
  METHODS
  Twelve-month, continuous treatment with oral ethinyl E2, 0.01 mg, plus cyproterone acetate, 3 mg/day, or norethindrone acetate, 2.5 mg/day.
  
  
  METHODS
  Degree of satisfaction with therapy.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Clinica Ostetrica e Ginecologica I, University of Milan, Istituto Luigi Mangiagalli, Milan, Italy. paolo.vercellini@unimi.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Vercellini
authors.forename: Giuliana
authors.initials: G
authors.lastname: Pietropaolo
authors.forename: Olga
authors.initials: O
authors.lastname: De Giorgi
authors.forename: Roberta
authors.initials: R
authors.lastname: Pasin
authors.forename: Annalisa
authors.initials: A
authors.lastname: Chiodini
authors.forename: Pier Giorgio
authors.initials: PG
authors.lastname: Crosignani
mesh_terms: D000293:Adolescent; D000328:Adult; D016001:Confidence Intervals; D004359:Drug Therapy, Combination; D004715:Endometriosis / Q000188:drug therapy* / Q000473:pathology; D015914:Estrogen Replacement Therapy / Q000379:methods*; D004967:Estrogens / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009640:Norethindrone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000077563:Norethindrone Acetate; D010147:Pain Measurement / Q000187:drug effects; D011372:Progestins / Q000008:administration & dosage*; D012002:Rectal Diseases / Q000188:drug therapy* / Q000473:pathology; D018709:Statistics, Nonparametric; D014623:Vaginal Diseases / Q000188:drug therapy* / Q000473:pathology
chemical_list: D004967:Estrogens; D011372:Progestins; D000077563:Norethindrone Acetate; D009640:Norethindrone