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Progestin for Endometriosis

Examples

Oral (pill)

Generic Name Brand Name
medroxyprogesterone Provera
megestrol Megace
norethindrone Camila, Micronor
norethindrone Aygestin
norethindrone plus estrogen Activella, Loestrin
norethindrone plus estrogen Brevicon, Modicon

Injection (into a muscle or under the skin)

Generic Name Brand Name
medroxyprogesterone Depo-Provera

One injection is given every 90 days.

Intrauterine device (IUD) with progestin

Generic Name Brand Name
levonorgestrel Mirena

Megestrol and Depo-Provera are high-dose progestins.

How It Works

Progestin shrinks endometriosis growths—which are also called implants—and reduces pain for most women.

Progestin is similar to the body's hormone progesterone. Taking progestin creates levels in the body similar to pregnancy. This stops monthly growth of the uterine lining (endometrium) and endometriosis implants elsewhere in the body. Progestin also reduces estrogen production, which stops ovulation and menstrual periods in most women.

The levonorgestrel (LNg) intrauterine device (IUD) is used to treat endometriosis. It releases a lower daily dose of levonorgestrel, a form of progestin, directly into the uterus. This causes fewer side effects than high-dose progestin pills or injections. In addition to reducing cramping and heavy menstrual bleeding, the LNg IUD is a highly effective method of birth control.

Why It Is Used

Progestin is a second-choice treatment for endometriosis. It is as effective as other hormone therapies. But it is typically used after birth control pills and/or gonadotropin-releasing hormone agonist (GnRH-a) therapies have not relieved endometriosis pain. This is because high-dose progestin, when given by mouth or injection, may cause bone-thinning and unpleasant side effects.1 (Megestrol and Depo-Provera are high-dose progestins. The progestin IUD is not known to have effects on the bone and causes fewer side effects because the progestin dose is lower.)

Progestin injection and the LNg IUD also effectively prevent pregnancy.

How Well It Works

Like all hormone therapies and surgery, progestin does not cure endometriosis.

Progestin may improve symptoms of endometriosis, such as pain during periods and pelvic pain. When compared with other hormone therapies, it has proved to be equally effective. Generally about 80% to 90% of women gain relief with any particular hormone therapy.1

Pain recurrence

After GnRH-a treatment, or any other hormone therapy, endometriosis pain can return.1

  • Each year, up to 20% of all women treated will have pain return after hormone treatment.
  • About 37% of women who use hormone therapy for mild endometriosis have pain 5 years later.
  • About 74% of women who use hormone therapy for severe endometriosis have pain 5 years later.

Side Effects

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after you take the medicine for a while.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call 911 or other emergency services right away if you have:

  • Trouble breathing.
  • Swelling of your face, lips, tongue, or throat.

Call your doctor if you have:

  • Hives.

Common side effects of this medicine include:

  • Absence of menstrual bleeding (amenorrhea).
  • Abnormal vaginal bleeding, such as irregular spotting to light vaginal bleeding.
  • Abdominal pain.
  • Breast tenderness.
  • Dizziness.
  • Mood changes.
  • Swelling of face, ankles, or feet.
  • Weight gain.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Progestins may cause bone loss. This usually improves after stopping the medicine.

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Advice for women

If you are pregnant, breast-feeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breast-feeding, or planning to get pregnant.

Checkups

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

References

Citations

  1. Fritz MA, Speroff L (2011). Endometriosis. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 1221–1248. Philadelphia: Lippincott Williams and Wilkins.

Credits

By Healthwise Staff
Primary Medical Reviewer Adam Husney, MD - Family Medicine
Specialist Medical Reviewer Kirtly Jones, MD - Obstetrics and Gynecology
Last Revised May 14, 2012

Last Revised: May 14, 2012

Author: Healthwise Staff

Medical Review: Adam Husney, MD - Family Medicine & Kirtly Jones, MD - Obstetrics and Gynecology

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