Desogestrel-only contraceptive pill versus sequential contraceptive vaginal ring in the treatment of rectovaginal endometriosis infiltrating the rectum: a prospective open-label comparative study

Objective To compare the efficacy of two hormonal therapies in treating symptoms caused by bowel endometriosis. Design Patient preference study. Setting University hospital. Population A total of 143 women with rectovaginal endometriosis infiltrating the rectum. Methods This study was performed between January 2008 and June 2011. Patients were treated with a desogestrel‐only contraceptive pill or with the sequential combined contraceptive vaginal ring for 12 months. Main outcome measures The primary endpoint of the study was the rate of satisfied patients at 12‐month follow up. The changes in symptoms and in the volume of the nodules were secondary endpoints. Results At 12‐month follow up, the rate of satisfied patients was higher in the group treated with the desogestrel‐only contraceptive pill than in the group treated with the sequential combined contraceptive vaginal ring (p = 0.004). When only changes in gastrointestinal symptoms were considered, 50% of patients treated with the desogestrel‐only contraceptive pill and 31.3% of those treated with the sequential combined contraceptive vaginal ring were satisfied (p = 0.037). The reduction in the volume of the nodules, the percentages of patients who discontinued the therapy after the completion of the study and of those who decided to undergo surgery were similar between the two groups. Conclusions Both hormonal therapies are efficacious in treating symptoms caused by rectovaginal endometriosis infiltrating the rectum. Patient satisfaction is higher with the desogestrel‐only pill than with a vaginal ring.