Progestin-only pills may be a better first-line treatment for endometriosis than combined estrogen-progestin contraceptive pills

There is evidence combined oral contraceptives should be replaced by progestins alone as the firstline therapy for endometriosis.

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Volume 107, Issue 3, Pages 533-536


Robert F. Casper, M.D.


For decades, combined estrogen-progestin oral contraceptive pills (OCPs) have been the first-line treatment for menstrual and pelvic pain associated with endometriosis without any clinical evidence of efficacy. Initial relief provided by OCPs is likely a result of improvement in primary dysmenorrhea. Biologic data and limited clinical evidence support a potential adverse effect of long-term use of OCPs on the progression of endometriosis. In contrast, there is randomized, controlled trial data to support the use of oral progestin-only treatment for pelvic pain associated with endometriosis and for suppressing the anatomic extent of endometriotic lesions. Both norethindrone acetate and dienogest have regulatory approval for treating endometriosis and may be better than OCPs as a first-line therapy.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility┬« is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. 


Go to the profile of Alexander Quaas
almost 5 years ago
You make a convincing argument for progestins instead of combined oral contraceptives as first-line treatment of endometriosis. Is it time for a head-to-head randomized controlled trial (OCPs versus POPs) or is this study not feasible because it would require a very large number of patients to be enrolled to show a difference? If that trial is not possible and is not going to get done, what will it take for the guideline makers to change their recommendations?