Progestogens for endometriosis

Long-acting progestogens can be used first line for endometriosis as an alternative to combined hormonal contraception, particularly if estrogen is contraindicated. They offer effective symptom management and contraception and require less user involvement.

Long-acting progestogens suitable for endometriosis include the 52 mg levonorgestrel-releasing intrauterine contraceptive device (LNG-IUD), etonogestrel implant, and medroxyprogesterone depot injection.

For treatment of endometriosis with a long-acting progestogen, use:

1 etonogestrel 68 mg implant, subdermally. Replace every 3 years endometriosis etonogestrel    

OR

1 levonorgestrel-releasing IUD 52 mg inserted into the uterus. Replace every 5 years endometriosis levonorgestrel-releasing iud    

OR

1 medroxyprogesterone 150 mg by deep intramuscular injection, every 12 weeks. endometriosis medroxyprogesterone medroxyprogesterone medroxyprogesterone

Oral progestogens are indicated if there is a contraindication to estrogens and long-acting progestogens. Patient acceptability of oral progestogens is poor due to the adverse effects such as breast tenderness, irregular bleeding and headaches. The usual length of treatment is 3 to 6 months, but longer or repeat courses are common. Their long-term use is limited by the risk of hypoestrogenism (affecting bone and possibly cardiovascular health).

Oral progestogens used for endometriosis reduce the likelihood of conception, but adequate contraception is not assured. Use an effective nonhormonal method of contraception if contraception is desired.

If an oral progestogen is appropriate for endometriosis, common regimens are:

1 norethisterone 5 to 10 mg orally, once daily; increase to 10 mg twice daily if spotting occurs endometriosis norethisterone    

OR

2 dienogest 2 mg orally, once daily endometriosis dienogest    

OR

2 medroxyprogesterone 10 mg orally, three times daily. medroxyprogesterone medroxyprogesterone medroxyprogesterone

Danazol is reserved for use by specialists when other treatments are not tolerated. It has significant adverse effects (eg hirsutism, acne, voice change, liver toxicity, dyslipidaemia, a small increase in the risk of ovarian cancer), and treatment duration is limited to 6 to 9 months. An effective nonhormonal method of contraception must be used concurrently during treatment with danazol.