SUPPRESSIVE THERAPY FOR CHRONIC PELVIC PAIN IN PATIENTS WITH EXTERNAL GENITAL ENDOMETRIOSIS

Objective. To study the efficiency of dienogest therapy in patients with chronic pelvic pain and external genital endometriosis (EGE), by taking into account estrogen metabolism. Subject and methods. Fifty-eight patients (mean age 29±1.7 years) with chronic pelvic pain and a laparoscopically verified diagnosis of EGE were examined. Group 1 consisted of patients with 2 OHE1/16 OHE estrogen metabolite ratios less than 2.0; Group 2 included patients with normal metabolism (a 2 OHE1/16 OHE1 ratio of more than 2.0). After surgical treatment for EGE, all the patients took the progestagen Dienogest 2 mg 12 months after surgical treatment. Pain intensity was evaluated in scores, by applying a visual analogue scale (VAS). Results. Early age at menarche, a short menstrual cycle (25±1.6 days), more pronounced pain intensity (8.5 (VAS)), and severe EGE were more common in patients with converse estrogen metabolism (p<0.05). As compared with the baseline data, there was a significant reduction in pelvic pain (as shown by VAS) during suppressive therapy with dienogest 2 mg 12 months after surgical treatment (p<0.05). The patients with converse metabolism showed a significantly higher pain syndrome regression (from 8.5 to 1.4 scores) than those with normal metabolism (from 5.6 to 0.9 scores) (p<0.05). Conclusion. Suppressive therapy to decrease blood endogenous estradiol production is pathogenetically founded. Since EGE is a chronic recurring estrogen-dependent disease, it is necessary to perform long-term dienogest therapy to prevent a recurrence of the disease.

pelvic pain, estrogen metabolites, endometriosis, laparoscopy, suppressive therapy, dienogest