Vaginal danazol may alleviate severe endometriosis

. . . according to preliminary results from a small open-label prospective study.

Researchers included 21 women with deeply infiltrating endometriosis, all of whom underwent previous laparoscopic surgery and still reported recurrent severe dyspareunia, dysmenorrhea, pelvic pain, and in some cases, painful defecation. The women self-administered 200 mg/d vaginal danazol for 12 months.

Dysmenorrhea, dyspareunia, and pelvic pain significantly decreased within 3 months of treatment (P<0.01), disappeared after 6 months, and remained absent for the remainder of the 12-month treatment period. The treatment also relieved painful defecation. Ultrasound confirmed reduced nodularity in the rectovaginal septum within 6 months. Few adverse effects were noted, and treatment did not affect endometrial thickness or the women's menstrual cycles.

Razzi S, Luisi S, Calonaci F, et al. Efficacy of vaginal danazol treatment in women with recurrent deeply infiltrating endometriosis. Fertil Steril. 2007;88:789-794

Commentary from Nanette F. Santoro, MD, Professor and Director, Division of Reproductive Endocrinology, Department of Ob/Gyn and Women's Health, Albert Einstein College of Medicine, Bronx, NY.

Everything old is new again. The authors have resurrected a highly effective but often toxic oral therapy-danazol-and have managed to render it useful by changing the route of administration to vaginal, thereby permitting much lower dosing. At these low doses, presumably by increasing local tissue levels, excellent efficacy was observed without the many annoying side effects experienced by patients taking higher doses orally. Confirmation in larger trials may provide a welcome alternative for patients with endometriosis.