CoChat
Sign Up
Cited by 250Endometriosis Research and TreatmentEctopic Pregnancy Diagnosis and ManagementMenstrual Health and Disorders

Progestagens and anti-progestagens for pain associated with endometriosis

Open access
Brown, Julie, Kives, Sari, Akhtar, Muhammad·2012·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd002122.pub2PMC PMC6885053
Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUND: Endometriosis is a chronic inflammatory condition defined by the presence of glands and stroma outside the uterine cavity. It occurs in 7% to 10% of all women of reproductive age and may present as pain or infertility. The pelvic pain may be in the form of dysmenorrhoea, dyspareunia or pelvic pain. Initially a combination of estrogens and progestagens was used to create a pseudopregnancy and alleviate the symptoms associated with endometriosis. Progestagens alone or anti-progestagens have been considered as alternatives because they are inexpensive and may have a better side effect profile than other choices. OBJECTIVES: To determine the effectiveness of both the progestagens and anti-progestagens in the treatment of painful symptoms ascribed to the diagnosis of endometriosis. SEARCH METHODS: We used the search strategy of the Menstrual Disorders and Subfertility Group to identify all publications which described or might have described randomised controlled trials (RCTs) of any progestagen or any anti-progestagen in the treatment of symptomatic endometriosis. We updated the review in 2011. SELECTION CRITERIA: We considered only RCTs which compared the use of progestagens and anti-progestagens with other interventions, placebo or no treatment for the alleviation of symptomatic endometriosis. DATA COLLECTION AND ANALYSIS: We have added six new studies, bringing the total of included studies to 13 in the update of this review. The six newly included studies evaluated progestagens (comparisons with placebo, danazol, oral or subdermal contraceptive, oral contraceptive pill and danazol, gonadotrophin-releasing hormone (GnRH) analogue and other drugs). The remaining studies compared the anti-progestagen gestrinone with danazol, GnRH analogues or itself. MAIN RESULTS: The progestagen medroxyprogesterone acetate (100 mg daily) appeared to be more effective at reducing all symptoms up to 12 months of follow-up (MD -0.70, 95% CI -8.61 to -5.39; P < 0.00001) compared with placebo. There was evidence of significantly more cases of acne (six versus one) and oedema (11 versus one) in the medroxyprogesterone acetate group compared with placebo. There was no evidence of a difference in objective efficacy between dydrogesterone and placebo.There was no evidence of a benefit with depot administration of progestagens versus other treatments (low dose oral contraceptive or leuprolide acetate) for reduced symptoms. The depot progestagen group experienced significantly more adverse effects.There was no overall evidence of a benefit of oral progestagens over other medical treatment at six months of follow-up for self-reported efficacy. Amenorrhoea and bleeding were more frequently reported in the progestagen group compared with other treatment groups.There was no evidence of a benefit of anti-progestagens (gestrinone) compared with danazol. GnRH analogue (leuprorelin) was found to significantly improve dysmenorrhoea compared with gestrinone (MD 0.82, 95% CI 0.15 to 1.49; P = 0.02) although it was also associated with increased hot flushes (OR 0.20, 95% CI 0.06 to -0.63; P = 0.006). AUTHORS' CONCLUSIONS: There is only limited evidence to support the use of progestagens and anti-progestagens for pain associated with endometriosis.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1002/14651858.cd002122.pub2

Cites

54 of 54 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • In a meta-analysis of two small studies, gestrinone was effective in reducing pain.

    “In a meta-analysis including two small studies, treatment with gestrinone resulted effective in reduction of pain [214].”

    From Hormonal treatments for endometriosis: The endocrine background (2022) · cites this paper as [214]

    The Anti-progestagens section identifies two studies comparing gestrinone with danazol, but one enrolled 269 women, so they were not both small studies. The Efficacy section reports no difference in pain between those treatments, and the review found no gestrinone trials against placebo or no treatment; the two-study comparison therefore does not establish the claimed pain-reduction effect. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • MPA is more effective than placebo in reducing endometriosis-related pain.

    “MPA appeared to be more effective than placebo [214] and as effective as danazol [215] and GnRH-agonists [216, 217] in reducing endometriosis-related pain.”

    From Hormonal treatments for endometriosis: The endocrine background (2022) · cites this paper as [214]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. [4]4. Yang D, Ma W, Qu F, Ma B. Comparative study of Yiweining and gestrinone for post-operational treatment of stage 3 endometriosis. Chinese Journal of Integrative Medicine 2006;12(3):218-20.
  2. [19]19. Lancaster JM, Prentice A, Smith SK. Successful medical treatment of sub-diagphragmatic endometriosis. Journal of Obstetrics and Gynaecology 1995;15:206-9.

Cited by

Sorted by citations

Related

Authors
Brown, J., Kives, S., & Akhtar, M.
Affiliations
  • University of Auckland (NZ)
  • St. Michael's Hospital (CA)
  • University Hospital Coventry (GB)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2012-03-14
Volume
2012
Issue
3
Pages
CD002122-CD002122
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd002122.pub2
PMC
PMC6885053
OpenAlex
W1815118832
Semantic Scholar
4ff654b85ed5b03119ae3e0325a8b2235061cd57
Cited by
250
References
54
Citations by year
2026: 3 · 2025: 12 · 2024: 17 · 2023: 14 · 2022: 13 · 2021: 20 · 2020: 11 · 2019: 12 · 2018: 14 · 2017: 14 · 2016: 11 · 2015: 9 · 2014: 24 · 2013: 15 · 2012: 4
FWCI
2.26
Type
journal article
Language
en
Update notices
new_version (2025-10-09)
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Menstrual Health and Disorders
Keywords
endometriosis, pelvic pain, dysmenorrhea, dyspareunia, progestogens, medroxyprogesterone acetate, dydrogesterone, gestrinone, danazol, GnRH analogues, oral contraceptives, acne, edema, treatment efficacy, adverse effects, infertility, pseudopregnancy
MeSH terms
Danazol, Dydrogesterone, Endometriosis, Female, Gestrinone, Humans, Gonadotropin-Releasing Hormone, Progestins, Leuprolide, Medroxyprogesterone Acetate, Pelvic Pain, Progesterone Congeners

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review