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Progestogens for endometriosis: forward to the past
Paolo Vercellini1, Luigi Fedele, Giuliana Pietropaolo
1Clinica Ostetrica e Ginecologica I, Istituto Luigi Mangiagalli, Università di Milano, Milano, Italy. paolo.vercellini@unimi.it
Human Reproduction Update
|August 21, 2003
Summary
Progestogens are effective treatments for endometriosis pain, offering a safe and affordable alternative to surgery. They work by reducing inflammation and promoting endometrial cell death, with various administration methods available.
Area of Science:
- Gynecology
- Reproductive Endocrinology
- Pharmacology
Background:
- Endometriosis is a chronic inflammatory condition characterized by ectopic endometrial tissue.
- Current treatments include surgery and hormonal therapies, with varying efficacy and side effect profiles.
Purpose of the Study:
- To review the biological mechanisms of progestogen action in endometriosis.
- To define available progestogen therapies, including doses, routes, efficacy, and tolerability.
Main Methods:
- Comprehensive literature search of MEDLINE and EMBASE databases.
- Inclusion of English-language studies published within the last decade.
- Focus on progestogen use for endometriosis treatment.
Main Results:
- Progestogens inhibit endometrial implantation, angiogenesis, and inflammation.
- They increase endometrial apoptosis and promote disease quiescence through anovulation and decidualization.
- Effective pain relief in approximately 75% of women, comparable to other treatments.
- Multiple administration routes (oral, IM, SC, intravaginal, intrauterine) offer flexibility.
Conclusions:
- Progestogens are a well-tolerated, cost-effective, and safe medical alternative to surgery for endometriosis.
- Long-term medical management is crucial for sustained therapeutic benefit.
- Contraceptive effects necessitate careful consideration for women desiring future fertility.