Hormonal Treatment of Bowel Endometriosis

Colorectal surgery is required when bowel endometriosis cause subocclusive or occlusive symptoms. Several studies showed that in the other patients, hormonal therapies can improve both pain and intestinal complaints in about two-thirds of women with bowel endometriosis. Progestins (such as norethindrone acetate, dienogest, and desogestrel) and combined estroprogestin combinations are efficacious in the treatment of symptoms caused by bowel endometriosis, they are safe and well tolerated. Gonadotrophin-releasing hormone agonists (GnRH-a) and aromatase inhibitors (AIs) can improve the symptoms caused by bowel endometriosis but they cause relevant adverse effect which limit their long-term use. Patients receiving long-term hormonal therapy must be monitored during treatment, because intestinal nodules may progress despite the use of these therapies. Patients receiving hormonal therapies must be informed that this treatment induces only temporary relief of symptoms which usually recur few months after discontinuation of therapies; thus, these therapies are not expected to be definitively curative. Based on this, patients choosing the hormonal therapy should continue the treatment for many years, ideally until a pregnancy is desired or the physiologic menopause ensues.