Cochrane Database Syst Rev

Is progestogen treatment effective for endometriosis pain?

October 13, 2025

Study details: This Cochrane review included 33 randomized trials (N = 5,059) of reproductive-aged individuals with laparoscopically confirmed endometriosis and pain symptoms. Interventions were oral, depot, and implantable progestagens, compared with placebo, oral contraceptives, GnRH agonists/antagonists, and other progestagen regimens. Primary outcomes were pain (overall, pelvic, dysmenorrhea); secondary outcomes included quality of life, satisfaction, and adverse effects.

Results: Oral progestagens vs. placebo showed a moderate reduction in overall pain on a visual analogue scale (mean difference [MD], -2.58; 95% confidence interval, -3.13 to -2.03; moderate certainty) and dysmenorrhea (risk ratio [RR], 0.21), with improved quality of life (SF-36 score MD, 4.11; high certainty). Compared with oral contraceptives or GnRH agonists, oral progestagens had similar efficacy for pain and quality of life, but depot progestagens had fewer cumulative side effects than GnRH agonists. Adverse effects were comparable across groups, with spotting/irregular bleeding most common.

Clinical impact: Progestagens are an effective first-line option for endometriosis pain, with efficacy comparable to other hormonal therapies and a favorable safety profile. Individual response and tolerability should guide agent selection, as no single regimen is clearly superior.

Source:

Chen I, et al. (2025, October 9). Cochrane Database Syst Rev. Progestagens for pain symptoms associated with endometriosis. https://pubmed.ncbi.nlm.nih.gov/41065045/