Progestin for chronic pelvic pain

Examples

Oral (pill)

The dose of oral progestin is progressively increased until symptoms are relieved or you cannot tolerate the side effects.

Generic Name	Brand Name
norethindrone	Micronor, Norethin, Norlutin
norethindrone plus estrogen	Brevicon, Modicon, Nelova
norethindrone acetate	Aygestin
norethindrone acetate plus estrogen	Loestrin
medroxyprogesterone	Provera
megestrol acetate	Megace

Intramuscular (IM, into the muscle)

Generic Name	Brand Name
medroxyprogesterone acetate	Depo-Provera

Intrauterine device (IUD) with progestin

Generic Name	Brand Name
levonorgestrel IUD	Mirena

How It Works

Progestin, a synthetic version of the hormone progesterone, can relieve chronic pelvic pain by suppressing the menstrual cycle.

Why It Is Used

Progestin is used to treat chronic pelvic pain when:

• Symptoms are mild to moderate.
• Birth control is desired or childbearing is completed.

Injections of medroxyprogesterone acetate (Depo-Provera) can relieve chronic female pelvic pain and are also an effective form of birth control.

The levonorgestrel (LNg) intrauterine device (IUD) releases levonorgestrel, a form of progesterone, into the uterus. In addition to reducing cramping and heavy menstrual bleeding (dysfunctional uterine bleeding), this type of IUD is a highly effective method of birth control.

How Well It Works

Effect on chronic pelvic pain symptoms

• Symptoms improve.
• Pain during periods and pelvic pain are usually decreased.

Recurrence

Progestin is only a temporary solution. When treatment stops, the symptoms of chronic pelvic pain gradually return. Women with more severe pain are more likely to have symptoms return. This may happen earlier than in women with minimal symptoms.

Side Effects

The side effects of progestin treatment may include:

• Absence of menstrual bleeding (amenorrhea).
• Abnormal vaginal bleeding or spotting to light vaginal bleeding.
• Mood changes or depression.
• Water retention.
• Weight gain.

Depo-Provera risks

Depo-Provera use for 2 or more years can cause significant bone loss, which may not be fully reversible after stopping the medication.¹ (Infrequently, bone loss can lead to osteoporosis, which makes bones weak enough that they are more likely to break.)

Depo-Provera use makes chlamydia or gonorrhea infection more likely if you are sexually exposed to these bacteria.² Unless you are sure that your partner is free of infection, use a condom every time you have sex. (Some types of infection cause no symptoms.) Condom use helps protect you from getting a sexually transmitted disease.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

High-dose progestin:

• May be used to relieve symptoms and avoid surgery, particularly if you are close to menopause.
• Does not cure chronic pelvic pain, but it may be used to relieve symptoms, depending on whether you are able to tolerate the side effects.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

Author:	Kathe Gallagher, MSW	Last Updated: January 30, 2007
Medical Review:	Renée M. Crichlow, MD - Family Medicine Kirtly Jones, MD - Obstetrics and Gynecology
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