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[Progestogens and estroprogestins in the treatment of pelvic pain associated with endometriosis].

Abstract
We performed a MEDLINE and EMBASE search to identify all studies published in the English language literature on the use of progestogens for the treatment of endometriosis. The aim of our review was to clarify the biological rationale for treatment and define the drugs that can be used. It has been demonstrated that progestogens may prevent implantation and growth of regurgitated endometrium by inhibiting the expression of matrix metalloproteinases and angiogenesis, and they have several anti-inflammatory in vitro and in vivo effects that may reduce the inflammatory state generated by the metabolic activity of the ectopic endometrium. Oral contraceptives increase the abnormally low apoptotic activity of the endometrium of patients with endometriosis. Moreover, anovulation, decidualization, amenorrhoea and the establishment of a steady estrogen-progestogen milieu contribute to disease quiescence. Progestogens are able to control pain symptoms in approximately three out of four women with endometriosi. Different compounds can be administered by the oral, intramuscular, subcutaneous, intravaginal or intrauterine route, each with specific advantages or disadvantages. Medical treatment plays a role in the therapeutic strategy only if administered over a prolonged period of time. Given their good tolerability, minor metabolic effects and low cost, progestogens must therefore be considered drugs of choice and are currently the only safe and economic alternative to surgery. However, their contraceptive effectiveness limits their use to women who do not wish to have children in the short-term.
AuthorsR Daguati, E Somigliana, P Viganò, P Vercellini
JournalMinerva ginecologica (Minerva Ginecol) Vol. 58 Issue 6 Pg. 499-510 (Dec 2006) ISSN: 0026-4784 [Print] Italy
Vernacular TitleTerapia progestinica ed estroprogestinica per il dolore pelvico associato ad endometriosi.
PMID17108880 (Publication Type: English Abstract, Journal Article, Review)
Chemical References
  • Drug Combinations
  • Norpregnenes
  • Progestins
  • estroprogestin
  • Ethinyl Estradiol
Topics
  • Administration, Oral
  • Drug Combinations
  • Endometriosis (complications)
  • Ethinyl Estradiol (administration & dosage, therapeutic use)
  • Female
  • Humans
  • Injections, Intradermal
  • Injections, Intramuscular
  • Norpregnenes (administration & dosage, therapeutic use)
  • Pelvic Pain (drug therapy, etiology)
  • Progestins (administration & dosage, therapeutic use)

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