Effectiveness of Different Progestin Modalities Compared to Other Hormonal Therapies for Endometriosis: A Systematic Review

Abstract

Objective: A systematic review was conducted with a study compilation of women with endometriosis in determining the evidence of the use of various progestin modalities compared to other hormonal therapies in improving endometriosis-associated pain, enhancing quality of life (QoL) and minimizing adverse effects and reccurrence of disease. Materials and Methods: This review carried out search strategies on various searching databases to analyze all comparisons of various progestin-only therapies with each other, other types of hormonal therapies, and placebo. The primary outcome is improvement of endometriosis-associated pain. Meanwhile, the secondary outcomes are the impact on QoL or treatment satisfaction, adverse effects, and disease recurrence. Results: Progestogen (including progestin-only contraceptives) combined oral contraceptives (COC), gonadotropinreleasing hormone (GnRH) agonists, and antagonists are the hormonal therapies that were included in this study. These hormonal therapies significantly decrease the symptoms and increase the patient’s QoL, particularly dienogest, the most used progestogen in the study. The recurrence of the disease was mentioned when progestinonly contraceptives were compared to each other, GnRH agonists and antagonists, which were similar. In addition, almost all of the studies mentioned that irregular bleeding was the most commonly observed adverse effect. Conclusion: Progestin-only contraceptives are similarly effective and could be more effective than other hormonal therapies in decreasing endometriosis-related symptoms, improving QoL, recurrence rate and minimizing adverse effects. This study also concludes that there is no definite statement on the superiority of specific kinds or administration routes of progestogen to other types of progestin or hormonal therapies.

Keywords

• Endometriosis
• progestin
• hormonal therapy