title: Efficacy and acceptability of long-term norethindrone acetate for the treatment of rectovaginal endometriosis.
abstract: OBJECTIVE
  To study the efficacy of long-term treatment with norethindrone acetate (NETA) in patients with rectovaginal endometriosis.
  
  
  METHODS
  This retrospective cohort study included 103 women with pain symptoms caused by rectovaginal endometriosis. Patients received NETA alone (2.5mg/day up to 5mg/day) for 5 years. Primary outcome was the degree of satisfaction with treatment after 5 years of progestin therapy. Secondary outcomes were the assessment of any variation in pain symptoms and the volumetric assessment of the disease by magnetic resonance imaging (MRI).
  
  
  RESULTS
  Sixty-one women completed the 5-year follow-up (61/103, 59.2%) with 16 women withdrawing because of adverse effects (38.1%). Overall, 68.8% (42/61) of the women who completed the study were satisfied or very satisfied of this long term NETA treatment. This represents a 40.8% (42/103) of the patients enrolled. Intensity of chronic pelvic pain and deep dyspareunia significantly decreased during treatment (p<0.001 versus baseline at 1 and 5year). Dyschezia improved after 1-year respect to baseline (p=0.008) but remained stable between first and second year (p=0.409). At the end of 5 years treatment, a radiological partial response was observed in 33 patients (55.9%, n 33/59); a stable disease in 19 patients (32.2%, n 19/59). Seven women (7/59, 11.9%) displayed a volumetric increase of rectovaginal endometriosis under NETA treatment.
  
  
  CONCLUSIONS
  Five-year therapy with NETA is safe and well tolerated by women with rectovaginal endometriosis. Due to its low cost and good pharmacological profile, it represents a good candidate for long-term treatment in this setting.
authors.affiliation: Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino - IST, Largo R. Benzi 10, 16132, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Morotti
authors.affiliation: Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino - IST, Largo R. Benzi 10, 16132, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy.
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Venturini
authors.affiliation: Department of Radiology, Galliera Hospital, via Mura delle Cappuccine 14, 16128, Genoa, Italy.
authors.forename: Ennio
authors.initials: E
authors.lastname: Biscaldi
authors.affiliation: Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino - IST, Largo R. Benzi 10, 16132, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Racca
authors.affiliation: Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino - IST, Largo R. Benzi 10, 16132, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy.
authors.forename: Luana
authors.initials: L
authors.lastname: Calanni
authors.affiliation: Department of Surgical and Diagnostic Sciences, IRCCS San Martino Hospital and National Institute for Cancer Research, University of Genoa, Largo Rosanna Benzi, 1, 16132, Genoa, Italy.
authors.forename: Valerio Gaetano
authors.initials: VG
authors.lastname: Vellone
authors.affiliation: Department of Surgical and Diagnostic Sciences, IRCCS San Martino Hospital and National Institute for Cancer Research, University of Genoa, Largo Rosanna Benzi, 1, 16132, Genoa, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Stabilini
authors.affiliation: Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino - IST, Largo R. Benzi 10, 16132, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy. Electronic address: simone.ferrero@unige.it.
authors.forename: Simone
authors.initials: S
authors.lastname: Ferrero
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004414:Dyspareunia / Q000188:drug therapy; D004715:Endometriosis / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D009640:Norethindrone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000077563:Norethindrone Acetate; D010147:Pain Measurement; D017060:Patient Satisfaction; D017699:Pelvic Pain / Q000188:drug therapy; D012002:Rectal Diseases / Q000188:drug therapy* / Q000473:pathology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014623:Vaginal Diseases / Q000188:drug therapy* / Q000473:pathology
chemical_list: D000077563:Norethindrone Acetate; D009640:Norethindrone
keywords: Endometriosis; Long-term; Medical treatment; Norethindrone acetate; Progestins