Letter to the editor: 'the efficacy of progestins in managing pain associated with endometriosis, fibroids and pre-menstrual syndrome: a systematic review'

This letter to the editor comments on Allen et al.’s 2025 systematic review evaluating the analgesic effects of progestins for pain associated with endometriosis, uterine fibroids, and premenstrual syndrome, highlighting that the review’s conclusions may be limited by restricted consideration of nonpharmacologic and surgical options, inability to meta-analyze due to heterogeneity in study protocols and dosing/routes, and a brief safety assessment that does not deeply compare thrombotic risks across different progestin types or comprehensively evaluate long-term metabolic effects. The authors note that standardizing protocols could improve comparability and enable quantitative synthesis, and they call for subgroup analyses and stronger long-term safety data (e.g., lipids, glucose, liver function) in future research. This paper is centrally about endometriosis — it specifically addresses a systematic review of progestins for analgesia in endometriosis-associated pain.

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