Safety of medical treatments for endometriosis
Abstract
INTRODUCTION: All medical treatments for endometriosis are equally effective in relieving pain. However, all of them alleviate pain symptoms for as long as they are used, but pain always relapses when medication is discontinued. Therefore, medications need to be used in the long term. AREAS COVERED: Formulations of estro-progestins that contain less than 50 µg of estrogen are associated with a low risk of venous thrombosis, myocardial infarction and stroke. When considering the neoplastic effects, data suggest that the overall risk of invasive cancer by age 60 is not increased in previous users of hormonal contraceptives. The use of progestins for contraception has never been associated with an increased risk of breast cancer, venous thromboembolism or bone fractures. Although more data on long-term therapy with progestins are needed, treatment of endometriosis with progestins may be feasible in women with metabolic or cardiovascular contraindications to estroprogestin. The other medications for the treatment of pain associated with endometriosis are less appropriate for long term administration because of side effects (danazol and GnRH analogues), costs (aromatase inhibitors and GnRH agonists) or necessity of complex regimens of associations (GnRH agonists and add back therapy or aromatase inhibitors plus progestins). EXPERT OPINION: Progestins and estroprogestins are safe drugs to use in the long term. Adherence to these medications may be high because, being a contraceptive, they are perceived less as a medication for the treatment of a disease. The annual cost of therapy compares favorably with other available medications. Progestins and estroprogestins represent the first-line medications for the treatment of endometriosis associated pain.
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Progestins can be safely used in women with contraindication to estrogens or who do not tolerate estrogens.
“can be safely used in those women with contraindication to estrogens [11] or in those who do not tolerate estrogens [12].”
From Oral and depot progestin therapy for endometriosis: towards a personalized medicine (2017) · cites this paper as [11]
Progestins do not increase significantly thrombotic risk.
“Major advantages of these drugs are that they do not increase the thrombotic risk”
From Oral and depot progestin therapy for endometriosis: towards a personalized medicine (2017) · cites this paper as [11]
Low costs of medication and a favorable side-effects profile can play a crucial role for long-term adherence to treatment.
“Low costs of medication and a favorable side-effects profile can play a crucial role for long-term adherence to treatment [1,11].”
From Oral and depot progestin therapy for endometriosis: towards a personalized medicine (2017) · cites this paper as [11]
Progestins could be adopted in women with metabolic or cardiovascular contraindication to estrogen-progestins.
“In addition, progestins do not increase significantly thrombotic risk and could be adopted in those women with metabolic or cardiovascular contraindication to estrogen-progestins [11].”
From Oral and depot progestin therapy for endometriosis: towards a personalized medicine (2017) · cites this paper as [11]
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- Authors
- Berlanda, N., Somigliana, E., Viganò, P., & Vercellini, P.
- Affiliations
- University of Milan (IT)
- Vita-Salute San Raffaele University (IT)
- Corresponding author
- Berlanda, Nicola
- Venue
- Expert Opinion on Drug Safety
- Publisher
- Informa Healthcare
- Published
- 2015-12-10
- Volume
- 15
- Issue
- 1
- Pages
- 21-30
- ISSN
- 1474-0338 (ISSN-L)
- 1744-764X
- OpenAlex
- W2204624009
- Semantic Scholar
- 28164a639c3e321f55a0eb455c3e43c081254174
- Cited by
- 78
- References
- 76
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 13 · 2023: 4 · 2022: 9 · 2021: 5 · 2020: 2 · 2019: 3 · 2018: 10 · 2017: 13 · 2016: 7
- FWCI
- 1.52
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Expert Opinion on Drug Safety (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
- Keywords
- endometriosis, progestins, estroprogestins, long-term hormonal therapy, venous thromboembolism, breast cancer risk, cardiovascular risk, danazol, GnRH agonist, aromatase inhibitors, add-back therapy, pain management, medication adherence, treatment costs
- MeSH terms
- Drug Combinations, Endometriosis, Ethinyl Estradiol, Female, Humans, Middle Aged, Norpregnenes, Progestins, Recurrence, Time Factors, Pelvic Pain, Medication Adherence
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