Progestagens and anti-progestagens for pain associated with endometriosis

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Abstract
Background Endometriosis is a gynaecological condition that presents either with the problem of infertility or with painful symptoms. The clinical observation of an apparent resolution of symptoms during pregnancy gave rise to the concept of treating patients with a pseudo‐pregnancy regime. Initially combinations of high dose oestrogens and progestagens were used but this was subsequently replaced by progestogens alone. More recently progestogens of both progestagens and anti‐progestagens in the treatment of symptomatiprogestogenssis 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 The search strategy of the Menstrual Disorders and Subfertility Group was utilised to identify all publications which described or might have described randomised trials of any progestagen or any anti‐progestagen in the treatment of symptomatic endometriosis. Selection criteria Trials were included if they were randomised and considered the effectiveness of either a progestagen or an anti‐progestagen in the treatment of painful symptoms associated with endometriosis. Data collection and analysis Seven studies were considered to be appropriate for inclusion in this review. Only three studies evaluating progestagens were included (comparison with placebo, danazol and oral contraceptive plus danazol). All other studies compared the anti‐progestagen, gestrinone, with other medical therapies. Main results Progestagens appear to be an effective therapy for the painful symptoms associated with endometriosis. Gestrinone is as effective as other established medical therapies (danazol and GnRH analogues). Authors' conclusions The limited available data suggests that both continuous progestagens and anti‐progestagens are effective therapies in the treatment of painful symptoms associated with endometriosis. Progestagens given in the luteal phase are not effective. These conclusions should be accepted cautiously due to a lack of data.