Buggio Laura, Lazzari Caterina, Monti Ermelinda, Barbara Giussy, Berlanda Nicola, Vercellini Paolo
Unità Operativa Dipartimentale Ginecologia Chirurgica e Endometriosi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Commenda, 12, 20122, Milan, Italy.
Arch Gynecol Obstet. 2017 Sep;296(3):435-444. doi: 10.1007/s00404-017-4448-z. Epub 2017 Jun 29.
We aim to provide a comprehensive overview of the role of the vagina as a route for drug delivery and absorption, with a particular focus on the use of vaginal hormonal compounds for the treatment of deep infiltrating symptomatic endometriosis.
A MEDLINE search through PubMed was performed to identify all published studies in English language on vaginal hormonal treatments for symptomatic endometriosis.
Main advantages of the vaginal route include avoidance of the hepatic-first pass metabolic effect, the possibility of using lower therapeutic dosages, and the reduction of side effects compared with the oral administration. Studies on endometriosis treatment mainly focused on the use of vaginal danazol (n = 6) and the contraceptive vaginal ring (n = 2). One pilot study evaluated the efficacy of vaginal anastrozole in women with rectovaginal endometriosis. Most investigations evaluated the vaginal use of hormonal agents in women with deep infiltrating endometriosis/rectovaginal endometriosis. Overall, a substantial amelioration of pelvic pain symptoms associated with endometriosis was observed, particularly of dysmenorrhea. A significant reduction in rectovaginal endometriotic nodule dimensions measured at ultrasound examination was detected by some but not all authors.
The vaginal route represents a scarcely explored modality for drug administration. High local hormonal concentrations might achieve a greater effect on endometriotic lesions compared with alternative routes. Future studies should focus on the use of the vagina for delivering target therapies particularly in patients with deeply infiltrating rectovaginal lesions.
我们旨在全面概述阴道作为药物递送和吸收途径的作用，特别关注阴道激素化合物在治疗深部浸润性症状性子宫内膜异位症中的应用。
通过PubMed进行MEDLINE检索，以识别所有用英语发表的关于阴道激素治疗症状性子宫内膜异位症的研究。
阴道给药途径的主要优点包括避免肝脏首过代谢效应、使用较低治疗剂量的可能性以及与口服给药相比副作用的减少。关于子宫内膜异位症治疗的研究主要集中在阴道用达那唑（n = 6）和避孕阴道环（n = 2）的使用上。一项试点研究评估了阴道用阿那曲唑对直肠阴道子宫内膜异位症女性的疗效。大多数研究评估了激素制剂在深部浸润性子宫内膜异位症/直肠阴道子宫内膜异位症女性中的阴道使用情况。总体而言，观察到与子宫内膜异位症相关的盆腔疼痛症状有显著改善，尤其是痛经。一些但并非所有作者检测到超声检查时直肠阴道子宫内膜异位结节尺寸有显著减小。
阴道给药途径是一种探索较少的给药方式。与其他途径相比，高局部激素浓度可能对子宫内膜异位病变产生更大的作用。未来的研究应关注利用阴道递送靶向治疗，特别是对于深部浸润性直肠阴道病变的患者。
