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BMC Women's Health
Published in: BMC Women's Health 1/2022

Open Access 01-12-2022 | Endometriosis | Research

Progestins in the symptomatic management of endometriosis: a meta-analysis on their effectiveness and safety

Authors: Jon-Benay Mitchell, Sarentha Chetty, Fatima Kathrada

Published in: BMC Women's Health | Issue 1/2022

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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.
Appendix
Available only for authorised users
Literature
1.
2.
Pospisilova E, Kiss I, Souckova H, Tomes P, Spicka J, Matkowski R, et al. Circulating endometrial cells: a new source of information on endometriosis dynamics. J Clinic Med. 2019;8(11):1938.CrossRef
3.
Machairiotis N, Stylianaki A, Dryllis G, Zarogoulidis P, Kouroutou P, Tsiamis N, et al. Extrapelvic endometriosis: a rare entity or an underdiagnosed condition? Diagn Pathol. 2013;8(1):194.CrossRefPubMedPubMedCentral
4.
Sasson IE, Taylor HS. Stem cells and the pathogenesis of endometriosis. Annals  New York Acad Sci. 2008;1127(1):106–15.CrossRef
5.
Murgia F, Angioni S, D’Alterio MN, Pirarba S, Noto A, Santoru ML, et al. Metabolic profile of patients with severe endometriosis: a prospective experimental study. Reproduc Sci. 2020;28(3):728–35.CrossRef
6.
D’Alterio MN, Giuliani C, Scicchitano F, Langana AS, Oltolina NM, Sorrentino F, et al. Possible role of microbiome in the pathogenesis of endometriosis. Minerva Obstet Gynecol. 2021;73(2):193.CrossRefPubMed
7.
Gezer A, Oral E. Progestin therapy in endometriosis. Women’s Health. 2015;11(5):643–52.PubMed
8.
Ghiasi M, Kulkarni MT, Missmer SA. Is endometriosis more common and more severe than it was 30 years ago? J Minim Invasive Gynecol. 2020;27(2):452–61.CrossRefPubMed
9.
Peterson CM, Johnstone EB, Hammoud AO, Stanford JB, Varner MW, Kennedy A, et al. Risk factors associated with endometriosis: importance of study population for characterizing disease in the ENDO Study. Am J Obstet Gynecol. 2013;208(6):451.1-11.CrossRef
10.
Zondervan KT, Becker CM, Missmer SA. Endometriosis. New England J Med. 2020;382(13):1244–56.CrossRef
11.
Shigesi N, Kvaskoff M, Kirtley S, Feng Q, Fang H, Knight JC, et al. The association between endometriosis and autoimmune diseases: a systematic review and meta-analysis. Human Reproduct Update. 2019;25(4):486–503.CrossRef
12.
Lee S-Y, Koo Y-J, Lee D-H. Classification of endometriosis. Yeungnam Univ J Med. 2021;38(1):10–8.CrossRefPubMed
13.
Johnson NP, Hummelshoj L, Adamson GD, Keckstein J, Taylor HS, Abrao MS, et al. World endometriosis society consensus on the classification of endometriosis. Human Reproduc. 2016;32(2):315–24.CrossRef
14.
Kiesel L, Sourouni M. Diagnosis of endometriosis in the 21st century. Climacteric. 2019;22(3):296–302.CrossRefPubMed
15.
Bontempo AC, Mikesell L. Patient perceptions of misdiagnosis of endometriosis: results from an online national survey. Diagnosis. 2020;7(2):97–106.CrossRefPubMed
16.
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;29(10):2686–94.CrossRef
17.
Becker CM, Gattrell WT, Gude K, Singh SS. Reevaluating response and failure of medical treatment of endometriosis: a systematic review. Fertil Steril. 2017;108(1):125–36.CrossRefPubMedPubMedCentral
18.
Gheorghisan-Galateanu A. Hormonal therapy in women of reproductive age with endometriosis: an update. Acta Endocrinol (Bucharest). 2019;15(2):276–81.CrossRef
19.
Vercellini P, Buggio L, Berlanda N, Barbara G, Somigliana E, Bosari S. Estrogen-progestins and progestins for the management of endometriosis. Fertility  Sterility. 2016;106(7):1552–71.CrossRefPubMed
20.
Moradi M, Parker M, Sneddon A, Lopez V, Ellwood D. Impact of endometriosis on women’s lives: a qualitative study. BMC Women’s Health. 2014;14(1):1–12.CrossRef
21.
Piacenti I, Viscardi MF, Masciullo L, Sangiuliano C, Scaramuzzino S, Piccioni MG, et al. Dienogest versus continuous oral levonorgestrel/EE in patients with endometriosis: what’s the best choice? Gynecol Endocrinol. 2021;37(5):471–5.CrossRefPubMed
22.
Nezhat C, Vang N, Tanaka PP, Nezhat C. Optimal management of endometriosis and pain. Obstetrics  Gynecol. 2019;134(4):834–9.CrossRef
23.
D’Alterio MN, Saponara S, Agus M, Laganà AS, Noventa M, Loi ES, et al. Medical and surgical interventions to improve the quality of life for endometriosis patients: a systematic review. Gynecol Surg. 2021;18(1):1–14.CrossRef
24.
25.
26.
27.
28.
29.
30.
31.
32.
Margatho D, Carvalho NM, Bahamondes L. Endometriosis-associated pain scores and biomarkers in users of the etonogestrel-releasing subdermal implant or the 52-mg levonorgestrel-releasing intrauterine system for up to 24 months. Eur J Contracept Reproduc Health Care. 2020;18(2):133–40.CrossRef
33.
34.
Petraglia F, Hornung D, Seitz C, Faustmann T, Gerlinger C, Luisi S, et al. Reduced pelvic pain in women with endometriosis: efficacy of long-term dienogest treatment. Archiv Gynecol Obstetr. 2011;285(1):167–73.CrossRef
35.
Morotti M, Sozzi F, Remorgida V, Venturini PL, Ferrero S. Dienogest in women with persistent endometriosis-related pelvic pain during norethisterone acetate treatment. Eur J Obstet Gynecol Reproduc Biol. 2014;183:188–92.CrossRef
36.
Vercellini P, Bracco B, Mosconi P, Roberto A, Alberico D, Dhouha D, et al. Norethindrone acetate or dienogest for the treatment of symptomatic endometriosis: a before and after study. Fertility Sterility. 2016;105(3):734-43.e3.CrossRefPubMed
37.
Morotti M, Venturini PL, Biscaldi E, Racca A, Calanni L, Vellone VG, et al. Efficacy and acceptability of long-term norethindrone acetate for the treatment of rectovaginal endometriosis. Eur J Obstet Gynecol Reproduc Biol. 2017;213:4–10.CrossRef
38.
Maiorana A, Incandela D, Parazzini F, Alio W, Mercurio A, Giambanco L, et al. Efficacy of dienogest in improving pain in women with endometriosis: a 12-month single-center experience. Archives  Gynecol Obstetr. 2017;296(3):429–33.CrossRef
39.
Römer T. Long-term treatment of endometriosis with dienogest: retrospective analysis of efficacy and safety in clinical practice. Archiv Gynecol Obstetr. 2018;298(4):747–53.CrossRef
40.
Vercellini P, Ottolini F, Frattaruolo MP, Buggio L, Roberto A, Somigliana E. Is shifting to a progestin worthwhile when estrogen–progestins are inefficacious for endometriosis-associated pain? Reproduct Sci. 2018;25(5):674–82.CrossRef
41.
Sansone A, De Rosa N, Giampaolino P, Guida M, Laganà AS, Di Carlo C. Effects of etonogestrel implant on quality of life, sexual function, and pelvic pain in women suffering from endometriosis: results from a multicenter, prospective, observational study. Archiv Gynecol Obstetr. 2018;298(4):731–6.CrossRef
42.
Lang J, Yu Q, Zhang S, Li H, Gude K, von Ludwig C, et al. Dienogest for treatment of endometriosis in Chinese women: a placebo-controlled, randomized, double-blind phase 3 study. J Women’s Health. 2018;27(2):148–55.CrossRef
43.
Yu Q, Zhang S, Li H, Wang P, Zvolanek M, Ren X, et al. Dienogest for treatment of endometriosis in women: a 28-week, open-label, extension study. J Women’s Health. 2019;28(2):170–7.CrossRef
44.
Carvalho N, Margatho D, Cursino K, Benetti-Pinto CL, Bahamondes L. Control of endometriosis-associated pain with etonogestrel-releasing contraceptive implant and 52-mg levonorgestrel-releasing intrauterine system: randomized clinical trial. Fertil Steril. 2018;110(6):1129–36.CrossRefPubMed
45.
Del Forno S, Mabrouk M, Arena A, Mattioli G, Giaquinto I, Paradisi R, et al. Dienogest or Norethindrone acetate for the treatment of ovarian endometriomas: can we avoid surgery? Eur J Obstet Gynecol Reproductive Biology. 2019;238:120–4.CrossRef
46.
Ferrero S, Scala C, Ciccarelli S, Vellone VG, Barra F. Treatment of rectovaginal endometriosis with the etonogestrel-releasing contraceptive implant. Gynaecol Endocrinol. 2019;36(6):540–4.CrossRef
47.
Cho B, Roh J-W, Park J, Jeong K, Kim T-H, Kim YS, et al. Safety and effectiveness of dienogest (Visanne®) for treatment of endometriosis: a large prospective cohort study. Reproductive Sci. 2020;12(3):905–15.CrossRef
48.
Barra F, Scala C, Leone Roberti Maggiore U, Ferrero S. Long-term administration of Dienogest for the treatment of pain and intestinal symptoms in patients with rectosigmoid endometriosis. J Clinic Med 2020; 9(1):154.
49.
Nirgianakis K, Vaineau C, Agliati L, McKinnon B, Gasparri ML, Mueller MD. Risk factors for non-response and discontinuation of dienogest in endometriosis patients: a cohort study. Acta Obstetricia et Gynecologica Scandinavica. 2020;100(1):30–40.CrossRefPubMed
50.
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. Reproduc Med Biol. 2021;20(3):345–51.CrossRef
51.
52.
Metadata
Title
Progestins in the symptomatic management of endometriosis: a meta-analysis on their effectiveness and safety
Authors
Jon-Benay Mitchell
Sarentha Chetty
Fatima Kathrada
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Women's Health / Issue 1/2022
Electronic ISSN: 1472-6874
DOI
https://doi.org/10.1186/s12905-022-02122-0

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