Effect of Vaginal Miodesin in Pentravan on the Response to Progestin Therapy in Patients with Deep Endometriosis and Adenomyosis

Abstract

Hugo Maia, Wilson Saback, Clarice Haddad and Paulo R Sitya

Introduction: The effects of Myodesin™ (Fagron, Brazil) on pain scores were investigated in a group of 18 patients with endometriosis who failed to respond to oral dienogest or Mirena.

Patient and Methods: Eighteen patients with endometriosis were enrolled for this study and divided into 2 groups according to the treatment scheme. Group A (n=10) comprised of patients who were using 2 mg of dienogest and continuing to have pain and breakthrough bleeding when treatment with vaginal Miodesin™ (500 mg/dose daily) (Fagron Brazil) was initiated. In Group B (n=8) patients were treated with Miodesin™ after they had been using a Mirena ™ unsuccessfully to treat endometriosis pain for at least 3 months. Myodesin™ was always dispensed through the vaginal mucosa dissolved in Pentravan™ (Fagron, Netherland) at bedtime. Hysteroscopy with endometrial biopsies were performed in 4 patients in the Mirena™ group to evaluate the cause of uterine bleeding and to assess the presence of aromatase and VEGF expression in the endometrium by immunohistochemistry.

Results: In this group of deep endometriosis patients treatment with Dienogest or Mirena ™ caused a modest albeit significant reduction in total pain scores (VAS). However after vaginal Myodesin™ treatment was initiated there was a significant further reduction in pain scores in both groups albeit the post treatment scores were significantly smaller in Group B than in Group A. In Mirena™ users with bleeding and pain aromatase and VEGF expressions were detected in ¾(75%) of endometria but they became negative after Myodesin™ treatment in all cases. A great reduction in endometrial vascularization was also observed.

Conclusion: Miodesin treatment increased the efficacy of Dienogest and Mirena™ to reduce pelvic pain in patients with deep endometriosis and adenomyosis that were not responding adequately to these treatments. At least in Mirena™ users this was accompanied by a reduction in endometrial vascularization and in both VEG|F aromatase expression in the endometrium.

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