Gonadotropin-releasing hormone agonist treatment for endometriosis of the rectovaginal septum

OBJECTIVE: This study was undertaken to evaluate the effectiveness of a 6-m onth course of gonadotropin-releasing hormone agonist treatment for patient s with symptomatic endometriosis of the rectovaginal septum. STUDY DESIGN: Fifteen patients with rectovaginal endometriosis and moderate to severe pain symptoms were the subjects of the study. None of these pati ents had either clinical or objective evidence of ovarian endometriosis, no r was there evidence of any obstructive lesions of the intestine or ureters . All patients were given leuprolide acetate depot at 3.75 mg, 1 ampule int ramuscularly every 28 days, and treatment had a planned-duration of 6 month s. Follow-up evaluations were set every 2 months during the treatment phase and every 3 months thereafter until the completion of 1 year after discont inuation of medical therapy. At each follow-up visit pain symptoms were rec orded, and clinical exploration, transvaginal ultrasonography, and transrec tal ultrasonography were performed. RESULTS: Two patients stopped the treatment early after the second and four th leuprolide doses; in both cases the reason was persistence of pain, and both requested a surgical solution. The other 13 patients showed a marked i mprovement with respect to pain during the 6-month treatment course but had early pain recurrence after drug suspension; 11 of them required further t reatment within the first year of follow-up. The failure rate of gonadotrop in-releasing hormone agonist therapy to produce 1-year pain relief after tr eatment discontinuation was 87% (13/15) on an intent-to-treat basis. The en dometriotic lesions showed a slight but significant reduction in size durin g therapy but had returned to the original volume within 6 months after ces sation of the gonadotropin-releasing hormone analog treatment. CONCLUSION: Our results suggest that gonadotropin-releasing hormone analogs should not be considered a real therapeutic alternative to surgical treatm ent for patients with symptomatic endometriosis of the rectovaginal-septum, except possibly in a limited and unpredictable number of cases.