Progestin for chronic pelvic pain

Examples

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Oral (pill)

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

Brand Name	Chemical Name
Norlutin	norethindrone

Brand Name	Chemical Name
Nelova	norethindrone plus estrogen

Brand Name	Chemical Name
Aygestin	norethindrone acetate

Brand Name	Chemical Name
Loestrin	norethindrone acetate plus estrogen

Brand Name	Chemical Name
Provera	medroxyprogesterone

Brand Name	Chemical Name
Megace	megestrol acetate

Intramuscular (IM, into the muscle)

Brand Name	Chemical Name
Depo-Provera	medroxyprogesterone acetate

Intrauterine device (IUD) with progestin

Brand Name	Chemical Name
Mirena	levonorgestrel IUD

How It Works

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

Why It Is Used

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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

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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

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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

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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.

References

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Citations

1. U.S. Food and Drug Administration (2004). Black box warning added concerning long-term use of Depo-Provera contraceptive injection. FDA Talk Paper No. T04-50. Available online: http://www.fda.gov/bbs/topics/ANSWERS/2004/ANS01325.html.

2. Morrison CS, et al. (2004). Hormonal contraceptive use, cervical ectopy, and the acquisition of cervical infections. Sexually Transmitted Diseases, 31(9): 561–567.

Credits

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Author	Kathe Gallagher, MSW
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman
Primary Medical Reviewer	Renée M. Crichlow, MD - Family Medicine
Specialist Medical Reviewer	Kirtly Jones, MD - Obstetrics and Gynecology
Last Updated	January 30, 2007