The Current Place of Progestins in the Treatment of Endometriosis

Karl-Werner Schweppe

Disclosures

Expert Rev of Obstet Gynecol. 2012;7(2):141-148. 

In This Article

Conclusion

During the last 30 years, new effective substances have been introduced for medical treatment of endometriosis, and after danazol, GnRH analogs became the standard in drug management of endometriosis.[50] Therefore, there has been a paucity of scientific interest in progestins in recent years. In a literature review on the subject, Vercellini et al.[51] found four randomized controlled trials with a very limited number of patients. In these studies the beneficial effect of progestins for the treatment of endometriosis-related complaints was confirmed. In the Cochrane review[52] of last year, the following conclusion was drawn: "It would appear that both continuous progestogens and the antiprogestogen, gestrinone are effective therapies for the treatment of painful symptoms associated with endometriosis. This conclusion is based on the limited data available in the seven included studies and should be treated with caution particularly in light of the absence of suitable placebo-controlled trials. Whilst continuous high-dose progestogen (medroxy-progesterone acetate) appears to be effective, luteal phase dydrogesterone is no more effective than placebo."

Progestins today have their place in the symptomatic management of pain and other symptoms related to endometriosis, when long-term medication is indicated, or when repeated courses of treatment are acceptable.

Further studies are necessary to clarify the length of treatment, type of progestin, dosage used, intermittent medication and combinations with other drugs, effective in the reduction of endometriosis. Because a chronic disease needs a long-term or intermittently repeated medication, and because progestins are relatively well tolerated, in low concentrations only have limited metabolic side effect, and are inexpensive, there may be new interest in the use of these drugs for the treatment of endometriosis-related symptoms in the future.

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