Dienogest for the treatment of deep endometriosis: case report and literature review.

A 38-year-old woman was found to have a deep 3.3-cm endometriotic nodule of the bladder, confirmed by cystoscopic resection and imaging. Ultrasound also confirmed a 2.6-cm vaginal fornix implant with similar appearance to the bladder mass. The patient's primary symptoms were mild dysmenorrhea, catamenial dysuria and hematuria. The patient conceived shortly after referral and 3 months post-delivery was offered surgical management but declined in favor of medical management. Dienogest 2 mg once a day was started and after 16 months of treatment, more than 50% reduction in the size of the bladder nodule was seen (pretreatment: 3.3 × 3.0 × 2.7 cm, volume: 13.9 cm(3) ; post-treatment: 2.8 × 2.3 × 1.0 cm, volume: 6.4 cm(3) ). The vaginal mass also decreased in size from a pretreatment value of 2.0 × 2.6 × 1.4 cm (3.8 cm(3) ) to 1.1 × 1.4 × 0.5 mm (0.40 cm(3) ) after the treatment. The patient remained asymptomatic with no significant adverse drug reaction during management. Dienogest may be one of the options for medical management of deep endometriosis in young women especially when surgical intervention is declined.