{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T06:10:36Z","timestamp":1790403036041,"version":"4.1.0"},"reference-count":30,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T00:00:00Z","timestamp":1753056000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objective: To assess the long-term effects of Dienogest on clinical complaints and nodule sizes in women affected by recto-sigmoid deep endometriosis (DE). Methods: This was a single-center longitudinal prospective observational study comprising a consecutive series of women affected by recto-sigmoid DE, who underwent medical treatment with Dienogest (2 mg daily continuous). All women underwent clinical visits and transvaginal sonography (TVS) with bowel preparation prior to starting therapy and at 3\u20136-month intervals for at least 12 months. Clinical complaints such as dysmenorrhea, dyspareunia and dyschezia were assessed using a visual analog scale (VAS). The DE recto-sigmoid lesion was measured in the three orthogonal planes. The lesion\u2019s volume was estimated using the prolate ellipsoid formula. The maximum diameter and lesion volume were used for analysis. Patients\u2019 complaints and lesion sizes before starting the treatment and at final follow-up were compared. Results: From January 2017 to July 2020, 125 patients were consecutively recruited (mean age: 37 years, ranging from 20 to 50 years). The median follow-up period was 47.8 months (range: 12\u201374 months). We did not observe a significant correlation between the severity of the symptoms and the lesion size prior to starting therapy. Clinical complaints improved significantly during treatment (88% of women were symptomatic at initial visit, versus 53% at final follow-up, p &lt; 0.001). The median lesion volume significantly decreased (median initial volume vs. final volume: 1.1 mL vs. 0.9 mL, p = 0.017). However, the median maximum lesion diameter did not change significantly (26.0 mm vs. 25.0 mm, p = 0.779). Conclusions: Long-term Dienogest therapy significantly relieves clinical symptoms related to recto-sigmoid DE. This is accompanied by a significant reduction in the lesion volume but not the maximum lesion diameter.<\/jats:p>","DOI":"10.3390\/jcm14145164","type":"journal-article","created":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T13:59:11Z","timestamp":1753106351000},"page":"5164","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The Effect of Dienogest on Deep Endometriosis Nodules Involving the Recto-Sigmoid Colon: A Prospective Longitudinal Long-Term Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9409-5909","authenticated-orcid":false,"given":"Carlos Andr\u00e9s","family":"Contreras","sequence":"first","affiliation":[{"name":"Centro Colpodiagn\u00f3stico IPS, Medell\u00edn 005021, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9386-0580","authenticated-orcid":false,"given":"Ignacio","family":"Brunel","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hospital QuironSalud, 29004 M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00f3nica","family":"Restrepo","sequence":"additional","affiliation":[{"name":"Centro Colpodiagn\u00f3stico IPS, Medell\u00edn 005021, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia Patricia","family":"Franco","sequence":"additional","affiliation":[{"name":"Centro Colpodiagn\u00f3stico IPS, Medell\u00edn 005021, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Clara","family":"Soto","sequence":"additional","affiliation":[{"name":"Centro Colpodiagn\u00f3stico IPS, Medell\u00edn 005021, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0460-9457","authenticated-orcid":false,"given":"Jos\u00e9 Carlos","family":"Vilches","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hospital QuironSalud, 29004 M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7521-0676","authenticated-orcid":false,"given":"Rodrigo","family":"Orozco","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hospital QuironSalud, 29004 M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1359-7155","authenticated-orcid":false,"given":"Stefano","family":"Guerriero","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, 09042 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9700-0853","authenticated-orcid":false,"given":"Juan Luis","family":"Alc\u00e1zar","sequence":"additional","affiliation":[{"name":"Centro Colpodiagn\u00f3stico IPS, Medell\u00edn 005021, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1056\/NEJMra1810764","article-title":"Endometriosis","volume":"382","author":"Zondervan","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"International Working Group of AAGL, ESGE, ESHRE and WES, Tomassetti, C., Johnson, N.P., Petrozza, J., Abrao, M.S., Einarsson, J.I., Horne, A.W., Lee, T.T.M., Missmer, S., and Vermeulen, N. (2021). An international terminology for endometriosis, 2021. Hum. Reprod. Open, 2021, hoab029.","DOI":"10.1093\/hropen\/hoab029"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1839","DOI":"10.1093\/humrep\/del079","article-title":"Deeply infiltrating endometriosis: Pathogenetic implications of the anatomical distribution","volume":"21","author":"Chapron","year":"2006","journal-title":"Hum. Reprod."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3440","DOI":"10.1093\/humrep\/des322","article-title":"Are digestive symptoms in women presenting with pelvic endometriosis specific to lesion localizations? A preliminary prospective study","volume":"27","author":"Roman","year":"2012","journal-title":"Hum. Reprod."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"35","DOI":"10.2147\/IJWH.S190326","article-title":"Bowel endometriosis: Current perspectives on diagnosis and treatment","volume":"29","author":"Habib","year":"2020","journal-title":"Int. J. Womens Health"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1093\/humupd\/dmv003","article-title":"Deep endometriosis infiltrating the recto-sigmoid: Critical factors to consider before management","volume":"21","author":"Abrao","year":"2015","journal-title":"Hum. Reprod. Update"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1016\/j.ajog.2017.09.023","article-title":"Bowel endometriosis: Diagnosis and management","volume":"218","author":"Nezhat","year":"2018","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.bpobgyn.2020.06.004","article-title":"Advances in the medical management of bowel endometriosis","volume":"71","author":"Vercellini","year":"2021","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"hoac009","DOI":"10.1093\/hropen\/hoac009","article-title":"ESHRE guideline: Endometriosis","volume":"2022","author":"Becker","year":"2022","journal-title":"Hum. Reprod. Open"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1007\/s00384-023-04352-6","article-title":"Conservative surgery versus colorectal resection for endometriosis with rectal involvement: A systematic review and meta-analysis of surgical and long-term outcomes","volume":"38","author":"Morarasu","year":"2023","journal-title":"Int. J. Color. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1016\/j.jmig.2021.02.007","article-title":"Impact of Surgery for Deep Infiltrative Endometriosis before In Vitro Fertilization: A Systematic Review and Meta-analysis","volume":"28","author":"Casals","year":"2021","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_12","first-page":"1669","article-title":"High postoperative fertility rate following surgical management of colorectal endometriosis","volume":"33","author":"Roman","year":"2018","journal-title":"Hum. Reprod."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1007\/s00404-020-05694-0","article-title":"Surgery-related complications and long-term functional morbidity after segmental colo-rectal resection for deep infiltrating endometriosis (ENDO-RESECT morb)","volume":"302","author":"Turco","year":"2020","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1016\/j.fertnstert.2023.05.156","article-title":"Long-term risk of repeated surgeries in women managed for endometriosis: A 1,092 patient-series","volume":"120","author":"Roman","year":"2023","journal-title":"Fertil. Steril."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1016\/j.jmig.2019.09.791","article-title":"Recurrence after Surgery for Colorectal Endometriosis: A Systematic Review and Meta-analysis","volume":"27","author":"Bendifallah","year":"2020","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.1016\/j.ijsu.2014.07.013","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies","volume":"12","author":"Altman","year":"2014","journal-title":"Int. J. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1002\/uog.15955","article-title":"Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: A consensus opinion from the International Deep Endometriosis Analysis (IDEA) group","volume":"48","author":"Guerriero","year":"2016","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1136\/bmj.313.7048.41","article-title":"Measurement error and correlation coefficients","volume":"313","author":"Bland","year":"1996","journal-title":"BMJ"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1177\/096228029900800204","article-title":"Measuring agreement in method comparison studies","volume":"8","author":"Bland","year":"1999","journal-title":"Stat. Methods Med. Res."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Ceccaroni, M., Baggio, S., Capezzuoli, T., Albanese, M., Mainardi, P., Zorzi, C., Foti, G., and Barra, F. (2024). Conservative Management of Bowel Endometriosis: Cross-Sectional Analysis for Assessing Clinical Outcomes and Quality-of-Life. J. Clin. Med., 13.","DOI":"10.20944\/preprints202406.0014.v1"},{"key":"ref_21","first-page":"2144","article-title":"Progression of deep infiltrating rectosigmoid endometriotic nodules","volume":"34","author":"Netter","year":"2019","journal-title":"Hum. Reprod."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1111\/aogs.13619","article-title":"Conservative treatment of rectosigmoid endometriosis: A prospective study","volume":"98","author":"Egekvist","year":"2019","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Barra, F., Scala, C., Leone Roberti Maggiore, U., and Ferrero, S. (2020). Long-Term Administration of Dienogest for the Treatment of Pain and Intestinal Symptoms in Patients with Rectosigmoid Endometriosis. J. Clin. Med., 9.","DOI":"10.3390\/jcm9010154"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1007\/s43032-020-00346-9","article-title":"Clinical and Sonographic Progression of Bowel Endometriosis: 3-Year Follow-up","volume":"28","author":"Abrao","year":"2021","journal-title":"Reprod. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1055\/a-2209-5653","article-title":"Sonomorphologic Changes in Colorectal Deep Endometriosis: The Long-Term Impact of Age and Hormonal Treatment","volume":"45","author":"Keckstein","year":"2024","journal-title":"Ultraschall Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"hoaa001","DOI":"10.1093\/hropen\/hoaa001","article-title":"Intra- and interobserver reproducibility of pelvic ultrasound for the detection and measurement of endometriotic lesions","volume":"2020","author":"Bean","year":"2020","journal-title":"Hum. Reprod. Open"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1111\/aogs.13343","article-title":"Intra- and interobserver variability in nodule size of rectosigmoid endometriosis measured by two- and three-dimensional transvaginal sonography","volume":"97","author":"Egekvist","year":"2018","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/S1074-3804(05)60117-X","article-title":"Routine clinical examination is not sufficient for diagnosing and locating deeply infiltrating endometriosis","volume":"9","author":"Chapron","year":"2002","journal-title":"J. Am. Assoc. Gynecol. Laparosc."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"hoaf012","DOI":"10.1093\/hropen\/hoaf012","article-title":"Fertility preservation in women with endometriosis","volume":"2025","author":"Semprini","year":"2025","journal-title":"Hum. Reprod. Open"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1093\/humrep\/deaf063","article-title":"\u2018Ovariostasis\u2019 as the main preventive and therapeutic strategy for gynecological pathologies in women of reproductive age","volume":"40","author":"Selmi","year":"2025","journal-title":"Hum. Reprod."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/14\/5164\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:13:19Z","timestamp":1760033599000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/14\/5164"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,21]]},"references-count":30,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["jcm14145164"],"URL":"https:\/\/doi.org\/10.3390\/jcm14145164","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,21]]}}}