The use of progestin subdermal implants in the management of endometriosis-related pain symptoms and quality of life: a systematic review

Abstract

Objective

The purpose of this systematic review is to evaluate the evidence for the use of progestin subdermal implants for the treatment of endometriosis-related pain symptoms and quality of life.

Methods

A literature search of PubMed, Ovid (MEDLINE and EMBASE), and Web of Science was performed from inception to December 2020. In addition, a targeted search of cited references was also performed. Our search identified 330 articles of which 17 were deemed eligible for full-text review. Eligible studies included randomized control trials, observational studies, and case series with at least 5 cases, investigating the effect of progestin subdermal implants on endometriosis-related pain scores in women of reproductive age with a clinical, radiologic, or surgical diagnosis of endometriosis. Six articles were excluded after the full-text screen.

Results

Eleven articles describing a total of 335 patients were eligible for inclusion. Across all studies, etonogestrel- and segesterone-releasing progestin subdermal implants improved VAS pain scores for cyclic pelvic pain/dysmenorrhea (VAS at baseline ranged from 6.1 to 7.5 cm and after treatment from 1.7 to 4.9 cm, n = 121), non-cyclic pelvic pain (baseline VAS 7.2–7.6 cm and after treatment 2.0–3.7 cm, n = 96) and dyspareunia (baseline VAS 1.61–8.3 cm and after treatment 1.0–7.1 cm, n = 87). Symptom improvement with the progestin subdermal implant was equivalent to treatment with depot medroxyprogesterone acetate (DMPA; average baseline VAS 6.5 and after DMPA treatment 3.0, compared to 2.0 after treatment with the implant) or the 52 mg levonorgestrel-releasing intrauterine system (LNG-IUS; baseline cyclic and non-cyclic pain scores 7.3 and 7.4 respectively decreased to 1.9 and 1.9 after LNG-IUS treatment). Improvements were also demonstrated in quality-of-life scores (average improvement of 36% in all domains of the Endometriosis Health Profile-30 and significant improvements in social functioning, general health, bodily pain, vitality and mental health domains on the Short Form-36 questionnaire) and sexual function (total sexual function score improved from 24 to 25.35 and 26.25 at 6 and 12 months).

Conclusion

Etonogestrel- and segesterone-releasing progestin subdermal implants appear to improve endometriosis-related pain symptoms and quality of life and may provide an additional component in the management of endometriosis. However, this systematic review is limited by the small sample size and heterogeneity in the data. As such, larger prospective randomized trials are needed to guide further management.

PROSPERO Registration

CRD42021225665

Keywords:

• Endometriosis
• progestin subdermal implant
• etonogestrel
• pelvic pain
• dysmenorrhea

Transparency

Declaration of funding

This study was not funded.

Declaration of financial/other relationships

AP Sanders receives consulting fees from Hologic and Abbvie and compensation for presentations from Bayer and Hologic. M Secter receives compensation for presentations from Bayer. There are no other conflicts or financial relationships to disclose. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

AP Sanders and K Ambacher were involved in the conception and design for this paper. All authors were involved in the interpretation of data, manuscript drafting and revising. Similarly, all authors approved the final draft and agree to be accountable for all aspects of the work.