{"paper_id":"2108c414-cabe-4d5d-b586-5299b73a98ef","body_text":"Vol.:(0123456789)\nArchives of Gynecology and Obstetrics (2025) 312:989–990 \nhttps://doi.org/10.1007/s00404-025-08032-4\nMATTER ARISING\nLetter to the editor: ‘the efficacy of progestins in managing pain \nassociated with endometriosis, fibroids and pre‑menstrual syndrome: \na systematic review’\nSongjie Liao1 · Di Xiao2,3 · Liqiu Kou1\nReceived: 21 March 2025 / Accepted: 7 April 2025 / Published online: 4 June 2025 \n© The Author(s) 2025\nTo the Editors,\n We were highly interested in reading the article by Allen \net al. [1]. Titled “The efficacy of progestins in managing pain \nassociated with endometriosis, fibroids, and pre-menstrual \nsyndrome: a systematic review.” This study provides a valu-\nable, comprehensive evaluation of the analgesic effects of \nprogestins in treating endometriosis, fibroids, and premen-\nstrual syndrome (PMS), offering essential insights for clini-\ncal decision-making. However, there are several limitations \nin the study that may affect the generalizability of its conclu-\nsions. Therefore, we propose the following suggestions to \nguide future research improvements:\nFirst, while the article provides a detailed assessment \nof the efficacy of progestins, it offers a limited analysis of \nother treatment approaches, such as surgical and physical \ntherapies. The selection of a treatment plan should consider \nvarious factors, including pharmacological therapies, surgi-\ncal interventions, and other nonpharmacological measures. \nTo better guide clinical practice, we recommend that future \nresearch include systematic reviews of multiple treatment \noptions rather than focusing exclusively on pharmacological \ntherapies. For instance, by incorporating large-scale clinical \ntrials and cohort studies, the efficacy of surgical and physical \ntreatments can be systematically evaluated and compared \nwith pharmacological therapies, thereby providing a more \ncomprehensive basis for decision-making.\nSecond, owing to significant differences in study proto-\ncols, drug dosages, and routes of administration, we were \nunable to perform a meta-analysis. This limitation means \nthat the authors could rely only on narrative analysis, lacking \na more systematic quantitative summary and comparison. \nMeta-analysis often provides more convincing conclusions, \nand the absence of this step affects the scientific rigor and \nreliability of an article. High heterogeneity across differ -\nent conditions, treatment regimens, drug dosages, and other \nvariables makes it difficult to unify the analysis, further lim-\niting the precise evaluation of the efficacy of the treatment \nmethods. We suggest that future studies standardize treat-\nment protocols and data collection methods at the design \nstage to ensure the comparability of studies and facilitate \nthe possibility of conducting a meta-analysis.\nFinally, this article provides a brief safety analysis, par -\nticularly regarding the discussion on thrombotic risks [2 ]. \nWhile progestins pose a lower thrombotic risk compared to \ncombined oral contraceptives, it does not explore in-depth \nthe differences in thrombotic risk among various types of \nprogestins (e.g., DMPA, dienogest) [3 ]. Future research \ncould include dedicated subgroup analyses to assess the \ndifferences in thrombotic risk in various populations. For \nexample, the impact of different dosages, routes of admin-\nistration, and underlying conditions (such as obesity and \nhypertension) on thrombotic risk can be analyzed. A detailed \nexamination of these aspects would contribute to a better \nunderstanding of the safety profiles of the different proges-\ntins. Another important issue is that the article does not sys-\ntematically assess the long-term metabolic effects of proges-\ntin therapy, such as its effects on lipid levels, blood glucose, \nand liver function [4]. Future studies should strengthen the \nanalysis of these areas to provide a more comprehensive \nevaluation of the long-term safety of progestins future stud-\nies should strengthen the analysis of these areas.\nAs clinical pharmacists, we play a crucial role in optimiz-\ning patient care, so we suggest that future studies focus more \n * Liqiu Kou \n 742560976@qq.com\n1 Department of Pharmacy, Zigong Maternal and Child Health \nCare Hospital, Zigong 643000, Sichuan, China\n2 Department of Pharmacy, The Afliated Hospital of Southwest \nMedical University, Luzhou 646000, Sichuan, China\n3 School of Pharmacy, Southwest Medical University, Luzhou, \nChina\n\n990 Archives of Gynecology and Obstetrics (2025) 312:989–990\non the standardization of drug dosages and routes of admin-\nistration, and strengthen the safety assessment of long-term \nprogestogen use, especially in terms of the effects on lipids, \nblood glucose, and liver function. In addition, individualized \ntreatment regimens should be considered, with drug adjust-\nments based on physiological differences in patients, and \nattention paid to drug interactions and patient adherence. \nThe issue of drug cost and resource allocation also needs \nto be addressed in studies in low- and middle-income coun-\ntries. Finally, clinical pharmacovigilance and international \ncollaboration can further optimize the use of progestins to \nimprove therapeutic efficacy and ensure safety.\nAlthough this review provides a valuable reference for \nthe management of endometriosis and uterine fibroids, \nthere is still room for improvement in terms of the quality \nof the studies, methodological limitations, uneven quality \nof data, and long-term assessment of side effects. We hope \nthat future studies will overcome these limitations, promote \nfurther optimization of gynecological pain management, and \nprovide more reliable evidence for clinical decision-making.\nAuthor contributions Songjie Liao: methodology, formal analysis, and \nwriting of the original draft; Di Xiao: methodology and writing of the \noriginal draft; Liqiu Kou: conceptualization, methodology, supervision, \nand writing review and editing.\nFunding No funding was received for this article.\nData availability No datasets were generated or analysed during the \ncurrent study.\nDeclarations \nConflict of interest The authors declare no conflict of interest.\nOpen Access  This article is licensed under a Creative Commons \nAttribution-NonCommercial-NoDerivatives 4.0 International License, \nwhich permits any non-commercial use, sharing, distribution and repro-\nduction in any medium or format, as long as you give appropriate credit \nto the original author(s) and the source, provide a link to the Creative \nCommons licence, and indicate if you modified the licensed material. \nYou do not have permission under this licence to share adapted material \nderived from this article or parts of it. The images or other third party \nmaterial in this article are included in the article’s Creative Commons \nlicence, unless indicated otherwise in a credit line to the material. If \nmaterial is not included in the article’s Creative Commons licence and \nyour intended use is not permitted by statutory regulation or exceeds \nthe permitted use, you will need to obtain permission directly from the \ncopyright holder. To view a copy of this licence, visit http:// creat iveco \nmmons. org/ licen ses/ by- nc- nd/4. 0/.\nReferences\n 1. Allen CL, Banerjee S, Karoshi M, Humaidan P, Tahmasebi F \n(2025) The efficacy of progestins in managing pain associated \nwith endometriosis, fibroids and pre-menstrual syndrome: a sys-\ntematic review. Arch Gynecol Obstet. https:// doi. org/ 10. 1007/  \ns00404- 025- 07957-0\n 2. Gavina BLA, de Los Reyes VA, Olufsen MS, Lenhart S, Ottesen \nJT (2023) Toward an optimal contraception dosing strategy. PLoS \nComput Biol 19(4):e1010073. https:// doi. org/ 10. 1371/ journ al. \npcbi. 10100 73\n 3. Barcellona D, Marongiu F, Grandone E (2024) Contraceptives \nand thrombosis: an intertwined revolutionary road. Semin Thromb \nHemost 50(1):91–95. https:// doi. org/ 10. 1055/s- 0043- 17643 82\n 4. Bick AJ, Louw-du Toit R, Skosana SB, Africander D, Hapgood JP \n(2021) Pharmacokinetics, metabolism and serum concentrations \nof progestins used in contraception. Pharmacol Ther 222: 107789. \nhttps:// doi. org/ 10. 1016/j. pharm thera. 2020. 107789\nPublisher's Note Springer Nature remains neutral with regard to \njurisdictional claims in published maps and institutional affiliations.","source_license":"CC0","license_restricted":false}