[The ranking of the gestagens in the treatment of pain caused by endometriosis--an overview]

Progestins are used for the treatment of endometriosis and endometriosis related complains in low dosages since more than four decades. Progestins induce incomplete regression of endometriotic implants only, they have a high recurrence rate, and they cause side effects--depending of the type of progestin and doses used--therefore GnRH-Agonist induced reversible ovarian suppression has become the standard in medical therapy for endometriosis prior and after surgery during the last ten years. New follow up studies have demonstrated the this new therapeutic principle is associated with relevant recurrence rates also and we have learned, that endometriosis is a chronic disease. For this background a medical therapy, which has low subjective and objective side effects, which can be used repeatedly or over a long time period, and which is cost effective becomes more important. This means that the place of progestins in the treatment of endometriosis has to be defined again and prospective randomised studies with the different substances are necessary.