Ebert Andreas D
Praxis für Frauengesundheit, Gynäkologie und Geburtshilfe, Nürnberger Strasse 67, 10787 Berlin, Germany.
Case Rep Obstet Gynecol. 2018 May 10;2018:8175870. doi: 10.1155/2018/8175870. eCollection 2018.
A 27-year-old patient suffering from deeply infiltrating rectovaginal endometriosis was treated with 2 mg/day dienogest vaginally for 3 months. The therapy was tolerated very well. The patient reported less side effects compared to the oral use of dienogest. After 3 months of dienogest treatment, the rectovaginal gynecological examination identified the visible vaginal part of endometriosis in remission. The firm endometriosis node approximately 3 cm in size and approximately 10 cm ab ano was still palpable, but it was much less painful. The laboratory values for luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were unremarkable, with an LH/FSH quotient of 0.7 during dienogest treatment, while 17- estradiol and progesterone were suppressed. At palpation and vaginal ultrasonography, there was no change in the findings before and after 3 months of dienogest treatment, but the patient was now de facto asymptomatic. To the best of our knowledge, this is the first report of a vaginal dienogest treatment in symptomatic deeply infiltrating rectovaginal endometriosis. Vaginal administration of dienogest should receive further investigation in pharmacokinetic and clinical studies.
一名27岁患有深度浸润性直肠阴道子宫内膜异位症的患者接受了每天2毫克地诺孕素经阴道给药治疗，为期3个月。该治疗耐受性良好。与口服地诺孕素相比，患者报告的副作用更少。地诺孕素治疗3个月后，直肠阴道妇科检查发现子宫内膜异位症的可见阴道部分已缓解。仍可触及大小约3厘米、距肛门约10厘米的坚实子宫内膜异位结节，但疼痛明显减轻。促黄体生成素（LH）和促卵泡生成素（FSH）的实验室值无异常，地诺孕素治疗期间LH/FSH比值为0.7，而17-β雌二醇和孕酮受到抑制。触诊和阴道超声检查显示，地诺孕素治疗3个月前后的检查结果无变化，但患者目前实际上无症状。据我们所知，这是关于有症状的深度浸润性直肠阴道子宫内膜异位症经阴道使用地诺孕素治疗的首例报告。地诺孕素经阴道给药应在药代动力学和临床研究中接受进一步研究。
