Role of medical therapy in the management of deep rectovaginal endometriosis
Open accessAbstract
Defining whether medical therapy is effective in women with deep rectovaginal endometriosis and in which circumstances it can be considered an alternative to surgery is important for patients and physicians. Numerous observational and some randomized controlled studies demonstrated that different hormonal drugs improved pain and other symptoms in approximately two-thirds of women with deep rectovaginal endometriosis. Because major differences in the effect size of various compounds were not observed, much importance should be given to safety, tolerability, and cost of medications when counseling patients. Progestins seem to offer the best therapeutic balance when long-term treatments are planned. Women should be informed that hormonal drugs control but do not cure endometriosis and that, to avoid surgery, they should be used for years. Medical therapy is not an alternative to surgery in women with hydronephrosis, severe subocclusive bowel symptoms, and in those wishing a natural conception. A progestin should systematically be chosen as a comparator in future randomized trials on novel medications for deep endometriosis. In the meantime, the use of existing drugs should be optimized, and medical and surgical treatments could be viewed as subsequent stages of a stepwise approach. In general, there is no absolute "best" choice, and women must be thoroughly informed of potential benefits, potential harms, and costs of different therapeutic options and allowed to choose what they deem is better for them.
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Hormonal treatments control endometriosis but do not definitively cure it.
“drugs control endometriosis but do not definitively cure it (28,31).”
From Medical treatment in the management of deep endometriosis infiltrating the proximal rectum and sigmoid colon: a comprehensive literature review (2018) · cites this paper as [31]
Lesion removal does not necessarily eliminate the biological processes that sustain pain.
“However, lesion removal does not necessarily eliminate the biological processes that sustain pain [8, 16, 24, 26].”
From Pain and functional outcomes after surgical versus hormonal treatment in rectovaginal endometriosis: a retrospective cohort study (2026) · cites this paper as [26]
Hormonal therapy suppresses ovarian activity and reduces cyclical hormonal stimulation of ectopic endometrial tissue, thereby decreasing inflammatory signalling and nociceptive input.
“Hormonal therapy, in contrast, does not remove lesions but suppresses ovarian activity and reduces cyclical hormonal stimulation of ectopic endometrial tissue, thereby decreasing inflammatory signalling and nociceptive input [6, 20, 26].”
From Pain and functional outcomes after surgical versus hormonal treatment in rectovaginal endometriosis: a retrospective cohort study (2026) · cites this paper as [26]
Hormonal treatment is well established for pain control in endometriosis in general.
“and hormonal treatment is well established for pain control in endometriosis in general [26]”
From Pain and functional outcomes after surgical versus hormonal treatment in rectovaginal endometriosis: a retrospective cohort study (2026) · cites this paper as [26]
The pathophysiology of pain in rectovaginal endometriosis is multifactorial and not determined solely by anatomical involvement.
“The pathophysiology of pain in RVE is multifactorial and not determined solely by anatomical involvement.”
From Pain and functional outcomes after surgical versus hormonal treatment in rectovaginal endometriosis: a retrospective cohort study (2026) · cites this paper as [26]
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Flagged first, then by citations
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“However, lesion removal does not necessarily eliminate the biological processes that sustain pain [8, 16, 24, 26].”
InfluentialLaparoscopic Segmental Bowel Resection
Ceccaroni, M., Clarizia, R., & Roviglione, G. (2020) · Springer eBooks · doi:10.1007/978-3-030-50446-5_12
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Grigorenko, A. (2021) · Reproductive Endocrinology · doi:10.18370/2309-4117.2021.59.61-65
Gonçalves, D. M. R. (2018) · doi:10.47749/t/unicamp.2018.1058125
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Dantas, E. H. M., Lessa, V. V. S., Cortez, A. C. L., Alves, J. C. C., Dessimoni, E. S., Vorkapic, C. F., Coelho, R. R., & Dantas, K. B. A. (2022) · Bookerfield Editora · doi:10.53268/bkf22040502
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Brick, A. V., & Braile, D. M. (2022) · Bookerfield Editora · doi:10.53268/bkf22040503
Kaizer, L. D., de Oliveira, L. S., Furlan, S., Carlin, M. P., & de Castro, L. F. (2022) · Bookerfield Editora · doi:10.53268/bkf22040507
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Brick, A. V., & Braile, D. M. (2022) · Bookerfield Editora · doi:10.53268/bkf22040504
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da Silva, R. W., de Godoy, J. R. P., & Longatti, S. C. (2022) · Bookerfield Editora · doi:10.53268/bkf22040501
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- Authors
- Vercellini, P., Buggio, L., & Somigliana, E.
- Affiliations
- University of Milan (IT)
- Corresponding author
- Vercellini, Paolo
- Venue
- Fertility and Sterility
- Publisher
- Elsevier BV
- Published
- 2017-12
- Volume
- 108
- Issue
- 6
- Pages
- 913-930
- ISSN
- 0015-0282 (ISSN-L)
- OpenAlex
- W2773939391
- Cited by
- 62
- References
- 97
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 3 · 2023: 7 · 2022: 13 · 2021: 8 · 2020: 12 · 2019: 3 · 2018: 8 · 2017: 3
- FWCI
- 1.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Fertility and Sterility (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
- Funders
- Ministero dell’Istruzione, dell’Università e della Ricerca
- Ferring Pharmaceuticals
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Keywords
- medical therapy, hormone therapy, progestins, surgical management, hydronephrosis, bowel symptoms, spontaneous conception, stepwise treatment, patient counseling, drug safety and tolerability
- MeSH terms
- Animals, Biopsy, Colposcopy, Endometriosis, Endometrium, Estrogens, Female, Hormones, Humans, Progestins, Rectal Diseases, Vaginal Diseases, Treatment Outcome
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