Gestagens in pharmacotherapy for endometriosis: pathogenetic rationale, long-term clinical efficacy and safety

Mekan R. Orazov, V.E. Radzinsky, Evgeny D. Dolgov
In: Voprosy ginekologii, akušerstva i perinatologii · 2024 · vol. 23(3) , pp. 78–85 · doi:10.20953/1726-1678-2024-3-78-85 · W4406864733
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-10 ⓘ

This review examines the pathogenetic rationale and clinical efficacy of gestagens, including dienogest, levonorgestrel, norethisterone acetate, medroxyprogesterone acetate, and dydrogesterone, for long-term endometriosis pharmacotherapy.

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This paper is a review assessing gestagens used in pharmacotherapy for endometriosis, framing their selection through pharmacological and clinical-pathogenetic considerations in relation to long-term efficacy and safety. It notes that international and federal guidelines favor gestagens for symptomatic endometriosis but argues that these protocols do not provide clear, group-level advantages and disadvantages for this broad class. The authors present commonly used progestins in clinical practice—dienogest, levonorgestrel, norethisterone acetate, medroxyprogesterone acetate, and dydrogesterone—with the stated aim of identifying the most effective, safe, and prioritized option for long-term treatment. This paper is centrally about endometriosis — it focuses on the pathogenetic rationale and long-term clinical efficacy and safety of gestagens used for endometriosis.

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Abstract

Endometriosis remains one of the most controversial diseases in modern gynecology. Many new discoveries regarding the pathogenesis of endometriosis raise even more questions in terms of therapeutic approaches to this nosology. According to international and federal guidelines, pharmacotherapy with gestagens is the preferred treatment for symptomatic endometriosis, but these protocols lack data on the specific advantages and disadvantages of such a broad pharmacological group. This review presents the most used gestagens in clinical practice not only from a pharmacological but also from a clinical-pathogenetic perspective to identify the most effective, safe, and prioritized progestin for the long-term treatment of endometriosis. Key words: endometriosis, gestagens, dienogest, levonorgestrel, norethisterone acetate, medroxyprogesterone acetate, dydrogesterone
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Gestagens in pharmacotherapy for endometriosis: pathogenetic rationale, long-term clinical efficacy and safety Mekan R.Orazov / Victor E. Radzinsky / Evgenii D. Dolgov / Endometriosis remains one of the most controversial diseases in modern gynecology. Many new discoveries regarding the pathogenesis of endometriosis raise even more questions in terms of therapeutic approaches to this nosology. According to international and federal guidelines, pharmacotherapy with gestagens is the preferred treatment for symptomatic endometriosis, but these protocols lack data on the specific advantages and disadvantages of such a broad pharmacological group. This review presents the most used gestagens in clinical practice not only from a pharmacological but also from a clinical-pathogenetic perspective to identify the most effective, safe, and prioritized progestin for the long-term treatment of endometriosis. Key words: endometriosis, gestagens, dienogest, levonorgestrel, norethisterone acetate, medroxyprogesterone acetate, dydrogesterone For citation: Orazov M.R., Radzinsky V.E., Dolgov E.D. Gestagens in pharmacotherapy for endometriosis: pathogenetic rationale, long-term clinical efficacy and safety. Vopr. ginekol. akus. perinatol. (Gynecology, Obstetrics and Perinatology). 2024; 23(3): 78–85. (In Russian). DOI: 10.20953/1726-1678-2024-3-78-85

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