Newer progestins in the treatment of endometriosis.

The use of the various new progestins in the treatment of endometrio sis is reported. Data from at least 6 separate investigators indicate an improvement rate of between 75% and 85%. In 1958 Kistner reported results in 12 patients using combinations of estrogen with the newer progestins over prolonged periods of time up to 9 months. A state of pseudopregnancy was brought about by gradually increasing the doses of both estrogenic and progestogenic substances. This seemed to be of particular value when the patient was infertile did not desire pregnancy or was unmarried. It has been determined that an excess of estrogen results in disturbing nausea at the onset of treatment breast tenderness and excessive vaginal discharge. Long-acting parenterally administered progestins have the advantage of constancy of dose and absorption. The caproate and acetate esters of 17alpha hydroxyprogesterone are effective but must be given with adequate estrogen. Norethynodrel with ethinyl estradiol has given excellent results in over 200 patients with proven endometriosis. The only disadvantage seems to be the occasional side effects of the estrogen. Provera one of the newer progestins is available in tablets of 2.5 and 10 mg and for intramuscular use in concentrations of 25 and 50 mg/cc. Greenblatt and Barfield have noted satisfactory results in the treatment of extensive endometriosis with oral Provera and an added estrogen. Norlutin-norethindrone is a true 19-nortestosterone and resembles the oral progestin Pranone. Norlutin is effective in treating patients with endometriosis. Hirsutism has been associated with the prolonged use of Norlutin. If hirsutism seems to be progressive while Norlutin is being administered it may be replaced with Enovid.