Endometriosis happens when tissue resembling endometrial tissue (that normally lines the uterus) grows outside of the uterus. These endometrial patches or lesions swell and shed in response to the hormones that regulate the menstrual cycle. However, being located outside of the uterus, the lesions cannot shed properly, which causes inflammation and pain. Over time, these lesions may become scar tissue.

Treatments to manage the symptoms of endometriosis include a broad class called progestins.

How progestins work

Progesterone is a hormone that is produced by the ovaries, the adrenal glands (small glands located over the kidneys), and the placenta during pregnancy. Progesterone acts on a receptor that signals the uterus to prepare for pregnancy following ovulation or the release of an egg from the ovaries. If the egg is fertilized, progesterone is involved in embryo and fetal development. If the egg is not fertilized, progesterone secretion stops, and menstruation begins.

Progestins are synthetic steroid hormones that mimic the actions of progesterone by binding to the same receptor.

The precise mechanism of how progestins treat endometriosis is not known, but it is thought that they prevent endometrial lesions from growing and may help the lesions waste away.

Progestins to treat endometriosis

The following progestin medications are commonly used to treat endometriosis:

Medroxyprogesterone

Depo-Provera contains the progestin medroxyprogesterone, and is administered by injection every 12 to 14 weeks.

Depo-SubQ-Provera 104 also contains medroxyprogesterone, but at a higher dose, and has been shown to reduce endometriosis-associated pain in clinical trials.

Cerazette (desogestrel)

An oral medication, Cerazette (desogestrel) is taken once a day to treat the symptoms of endometriosis. A clinical trial (NCT01559480) demonstrated that Cerazette can be effective in reducing endometriosis-associated pain following laparoscopic surgery.

Visanne (dienogest)

Visanne (dienogest) is another progestin treatment that has been shown to be effective in reducing endometriosis-associated pain, reducing endometrial lesions, and improving quality of life long-term (over 65 weeks of treatment).

Primolut N (norethisterone)

Primolut N (norethisterone) is an oral medication that can be taken twice daily to reduce pain and inflammation due to endometriosis. Two Phase 3 clinical trials (NCT03204318, NCT03204331) are currently recruiting patients with endometriosis to evaluate the safety and efficacy of Primolut N in combination with another medication, Relugolix (GnRH receptor antagonist).

Other information

Progestin treatment can cause side effects, including headaches, depression, fluid retention, nausea, lethargy, vomiting, and acne.

 

Last updated: July 30, 2019

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