title: Dienogest for the treatment of deep endometriosis: case report and literature review.
abstract: A 38-year-old woman was found to have a deep 3.3-cm endometriotic nodule of the bladder, confirmed by cystoscopic resection and imaging. Ultrasound also confirmed a 2.6-cm vaginal fornix implant with similar appearance to the bladder mass. The patient's primary symptoms were mild dysmenorrhea, catamenial dysuria and hematuria. The patient conceived shortly after referral and 3 months post-delivery was offered surgical management but declined in favor of medical management. Dienogest 2 mg once a day was started and after 16 months of treatment, more than 50% reduction in the size of the bladder nodule was seen (pretreatment: 3.3 × 3.0 × 2.7 cm, volume: 13.9 cm(3) ; post-treatment: 2.8 × 2.3 × 1.0 cm, volume: 6.4 cm(3) ). The vaginal mass also decreased in size from a pretreatment value of 2.0 × 2.6 × 1.4 cm (3.8 cm(3) ) to 1.1 × 1.4 × 0.5 mm (0.40 cm(3) ) after the treatment. The patient remained asymptomatic with no significant adverse drug reaction during management. Dienogest may be one of the options for medical management of deep endometriosis in young women especially when surgical intervention is declined.
authors.affiliation: Departments of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Sugandha
authors.initials: S
authors.lastname: Agarwal
authors.forename: Margaret Ann
authors.initials: MA
authors.lastname: Fraser
authors.forename: Innie
authors.initials: I
authors.lastname: Chen
authors.forename: Sukhbir Sony
authors.initials: SS
authors.lastname: Singh
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000188:drug therapy*; D005260:Female; D006727:Hormone Antagonists / Q000627:therapeutic use*; D006801:Humans; D009277:Nandrolone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D001745:Urinary Bladder Diseases / Q000188:drug therapy*; D014623:Vaginal Diseases / Q000188:drug therapy*
chemical_list: D006727:Hormone Antagonists; C023635:dienogest; D009277:Nandrolone
keywords: dienogest; endometriosis; pelvic pain; progestin