The Current Place of Progestins in the Treatment of Endometriosis

Karl-Werner Schweppe


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

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Expert Commentary

During the last 15 years it became clear that GnRH analogs as the standard of the past are very effective in controlling endometriosis during medication on the one hand, but on the other hand it is definitively not curative and recurrence of symptoms is only a question of time. Therefore, medical treatment of endometriosis-related symptoms requires a long-term application of the drug or repetitive phases of intake. In that case side effects – objective metabolic disturbances and subjective complaint – have to be taken into consideration as well as costs of the treatment prescribed. All three medical treatment options – GnRH analogs with add-back medication, progestins and nonsteroidal antirheumatics – can be given repetitively or over longer periods, but GnRH analogs are the most expensive option, and nonsteroidal antirheumatics can cause relevant side effects. Therefore, in most cases progestins are the first choice. In special situations – for example, in vitro fertilization in severe endometriosis – the use of GnRH analogs using the ultra long protocol is indicated, and in minimal disease with bleeding problems during progestin medication oral contraceptives with or without nonsteroidal antirheumatics may be the best alternative.


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