Progestins in the Symptomatic Management of Endometriosis: a Meta-analysis on Their Effectiveness and Safety

Overview

Journal BMC Womens Health

Publisher Biomed Central

Specialty Gynecology & Obstetrics

Date 2022 Dec 17

PMID 36528558

Authors

Jon-Benay Mitchell

Sarentha Chetty

Fatima Kathrada

Affiliations

Soon will be listed here.

Abstract

Background: Endometriosis is a complex chronic disease that affects approximately 10% of women of reproductive age worldwide and commonly presents with pelvic pain and infertility.

Method & Outcome Measures: A systematic review of the literature was carried out using the databases Pubmed, Scopus, Cochrane and ClinicalTrials.gov in women with a confirmed laparoscopic diagnosis of endometriosis receiving progestins to determine a reduction in pain symptoms and the occurrence of adverse effects.

Results: Eighteen studies were included in the meta-analysis. Progestins improved painful symptoms compared to placebo (SMD = -0.61, 95% CI (-0.77, -0.45), P < 0.00001) with no comparable differences between the type of progestin. After median study durations of 6-12 months, the median discontinuation rate due to adverse effects was 0.3% (range: 0 - 37.1%) with mild adverse effects reported.

Conclusion: The meta-analysis revealed that pain improvement significantly increased with the use of progestins with low adverse effects.

Systematic Review Registration: PROSPERO CRD42021285026.

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References

Kitawaki J, Koga K, Kanzo T, Momoeda M . An assessment of the efficacy and safety of dydrogesterone in women with ovarian endometrioma: An open-label multicenter clinical study. Reprod Med Biol. 2021; 20(3):345-351. PMC: 8254175. DOI: 10.1002/rmb2.12391. View

Giudice L, Kao L . Endometriosis. Lancet. 2004; 364(9447):1789-99. DOI: 10.1016/S0140-6736(04)17403-5. View

Nezhat C, Vang N, Tanaka P, Nezhat C . Optimal Management of Endometriosis and Pain. Obstet Gynecol. 2019; 134(4):834-839. DOI: 10.1097/AOG.0000000000003461. View

Nirgianakis K, Vaineau C, Agliati L, McKinnon B, Gasparri M, Mueller M . Risk factors for non-response and discontinuation of Dienogest in endometriosis patients: A cohort study. Acta Obstet Gynecol Scand. 2020; 100(1):30-40. DOI: 10.1111/aogs.13969. View

Gheorghisan-Galateanu A, Gheorghiu M . HORMONAL THERAPY IN WOMEN OF REPRODUCTIVE AGE WITH ENDOMETRIOSIS: AN UPDATE. Acta Endocrinol (Buchar). 2019; 15(2):276-281. PMC: 6711644. DOI: 10.4183/aeb.2019.276. View

Maiorana A, Incandela D, Parazzini F, Alio W, Mercurio A, Giambanco L . Efficacy of dienogest in improving pain in women with endometriosis: a 12-month single-center experience. Arch Gynecol Obstet. 2017; 296(3):429-433. DOI: 10.1007/s00404-017-4442-5. View

Ghiasi M, Thombre Kulkarni M, Missmer S . Is Endometriosis More Common and More Severe Than It Was 30 Years Ago?. J Minim Invasive Gynecol. 2019; 27(2):452-461. DOI: 10.1016/j.jmig.2019.11.018. View

Vercellini P, Bracco B, Mosconi P, Roberto A, Alberico D, Dhouha D . Norethindrone acetate or dienogest for the treatment of symptomatic endometriosis: a before and after study. Fertil Steril. 2015; 105(3):734-743.e3. DOI: 10.1016/j.fertnstert.2015.11.016. View

Piacenti I, Viscardi M, Masciullo L, Sangiuliano C, Scaramuzzino S, Piccioni M . Dienogest versus continuous oral levonorgestrel/EE in patients with endometriosis: what's the best choice?. Gynecol Endocrinol. 2021; 37(5):471-475. DOI: 10.1080/09513590.2021.1892632. View

10.

Sasson I, Taylor H . Stem cells and the pathogenesis of endometriosis. Ann N Y Acad Sci. 2008; 1127:106-15. PMC: 3107843. DOI: 10.1196/annals.1434.014. View

11.

Peterson C, Johnstone E, Hammoud A, Stanford J, Varner M, Kennedy A . Risk factors associated with endometriosis: importance of study population for characterizing disease in the ENDO Study. Am J Obstet Gynecol. 2013; 208(6):451.e1-11. PMC: 4114145. DOI: 10.1016/j.ajog.2013.02.040. View

12.

Machairiotis N, Stylianaki A, Dryllis G, Zarogoulidis P, Kouroutou P, Tsiamis N . Extrapelvic endometriosis: a rare entity or an under diagnosed condition?. Diagn Pathol. 2013; 8:194. PMC: 3942279. DOI: 10.1186/1746-1596-8-194. View

13.

Murgia F, Angioni S, DAlterio M, Pirarba S, Noto A, Santoru M . Metabolic Profile of Patients with Severe Endometriosis: a Prospective Experimental Study. Reprod Sci. 2020; 28(3):728-735. PMC: 7862197. DOI: 10.1007/s43032-020-00370-9. View

14.

Fauconnier A, Staraci S, Huchon C, Roman H, Panel P, Descamps P . Comparison of patient- and physician-based descriptions of symptoms of endometriosis: a qualitative study. Hum Reprod. 2013; 28(10):2686-94. DOI: 10.1093/humrep/det310. View

15.

Morotti M, Venturini P, Biscaldi E, Racca A, Calanni L, Vellone V . Efficacy and acceptability of long-term norethindrone acetate for the treatment of rectovaginal endometriosis. Eur J Obstet Gynecol Reprod Biol. 2017; 213:4-10. DOI: 10.1016/j.ejogrb.2017.03.033. View

16.

Johnson N, Hummelshoj L, Adamson G, Keckstein J, Taylor H, Abrao M . World Endometriosis Society consensus on the classification of endometriosis. Hum Reprod. 2016; 32(2):315-324. DOI: 10.1093/humrep/dew293. View

17.

Yu Q, Zhang S, Li H, Wang P, Zvolanek M, Ren X . Dienogest for Treatment of Endometriosis in Women: A 28-Week, Open-Label, Extension Study. J Womens Health (Larchmt). 2018; 28(2):170-177. DOI: 10.1089/jwh.2018.7084. View

18.

DAlterio M, Giuliani C, Scicchitano F, Lagana A, Oltolina N, Sorrentino F . Possible role of microbiome in the pathogenesis of endometriosis. Minerva Obstet Gynecol. 2021; 73(2):193-214. DOI: 10.23736/S2724-606X.21.04788-2. View

19.

Kiesel L, Sourouni M . Diagnosis of endometriosis in the 21st century. Climacteric. 2019; 22(3):296-302. DOI: 10.1080/13697137.2019.1578743. View

20.

Vercellini P, Buggio L, Berlanda N, Barbara G, Somigliana E, Bosari S . Estrogen-progestins and progestins for the management of endometriosis. Fertil Steril. 2016; 106(7):1552-1571.e2. DOI: 10.1016/j.fertnstert.2016.10.022. View