Estrogen dependence and progesterone resistance play a crucial role in the origin and development of
endometriosis. Therefore, hormonal
therapies are currently the most effective treatment.
Progestins are considered the first-line approach, especially for a long-term management.
Progestins are synthetic compounds that mimic the effects of
progesterone by binding
progesterone receptors. Continuous use of
progestins leads to the suppression of ovarian steroidogenesis with
anovulation and low serum levels of ovarian
steroids, causing endometrial pseudodecidualization. Moreover, they act by interfering on several
endometriosis pathogenetic pathways, decreasing
inflammation, provoking apoptosis in endometriotic cells, stimulating
atrophy or regression of endometrial lesions, inhibiting angiogenesis, and decreasing expression of
metalloproteinases, thus diminishing the invasiveness of endometriotic implants.
Progestins are effective for
pain relief and improvement of the quality of life (QoL). The side effects are limited, and the compounds are available in different formulations and routes of administration and represent, in most cases, an inexpensive treatment option.
Dienogest,
Medroxyprogesterone acetate and
Norethisterone acetate are the labeled
progestins for
endometriosis, but other
progestins, such as Dyhidrogesterone,
Levonorgestrel and
Desogestrel, have been shown to be effective in the treatment of
endometriosis-associated
pain. The present review aims to describe the available and emerging evidences on
progestins used for the treatment of
endometriosis.