From the Guidelines
Aygestin (norethindrone) is a viable treatment option for managing endometriosis and adenomyosis, particularly for reducing pain and bleeding, as supported by the most recent evidence 1.
Treatment Overview
Aygestin works by creating a pseudopregnancy state that reduces estrogen's stimulatory effects on endometrial tissue, thereby decreasing inflammation and preventing further tissue growth. It also thins the endometrial lining and reduces menstrual bleeding.
Dosage and Administration
For endometriosis, Aygestin is typically prescribed at doses of 5-15 mg daily continuously, while for adenomyosis, doses usually range from 5-10 mg daily.
Treatment Duration
Treatment duration varies from 6-12 months for endometriosis and may be longer for adenomyosis, with some patients requiring ongoing therapy.
Side Effects and Considerations
Common side effects include irregular bleeding, mood changes, weight gain, and breast tenderness. Patients should be aware that while Aygestin manages symptoms effectively, it doesn't cure either condition, and symptoms may return after discontinuation. It's not a contraceptive at the doses used for these conditions, so additional birth control may be needed if pregnancy prevention is desired.
Recent Evidence
A recent study published in 2024 1 supports the use of uterine artery embolization (UAE) for patients with adenomyosis and fibroids who fail conservative measures and desire uterus-preserving therapy, demonstrating improvement in quality of life and symptom scores. However, the use of Aygestin remains a valuable option for managing symptoms of endometriosis and adenomyosis, particularly when considering the potential benefits and risks of alternative treatments.
Key Points
- Aygestin is effective in reducing pain and bleeding associated with endometriosis and adenomyosis.
- Treatment duration and dosage may vary depending on the condition being treated.
- Patients should be aware of potential side effects and the need for additional birth control if pregnancy prevention is desired.
- Recent evidence supports the use of alternative treatments, such as UAE, but Aygestin remains a viable option for managing symptoms.
From the Research
Role of Aygestin in Treating Endometriosis and Adenomyosis
- Aygestin, also known as norethindrone, is a progestin that can be used to treat endometriosis and adenomyosis 2, 3, 4.
- Progestins, such as norethindrone, are considered a suitable long-term option for managing endometriosis, as they can reduce dysmenorrhea and other symptoms 2.
- Hormonal treatments, including progestins like Aygestin, aim to block menstruation and inhibit the progression of endometriotic implants 5.
- The levonorgestrel intrauterine system (LNG-IUS) is especially effective in patients with adenomyosis, but other progestins like Aygestin may also be used to treat this condition 2, 4.
Mechanism of Action
- Progestins like Aygestin work by causing pseudodecidualization, leading to amenorrhea and impairing the progression of endometriotic implants 5.
- Aygestin can also act on multiple sites, including the hypothalamus-pituitary-ovary axis, to reduce endometriosis symptoms 5.
Treatment Outcomes
- Hormonal treatments, including Aygestin, can lead to clinically significant pain reduction in patients with endometriosis, with mean differences ranging from 13.15 to 17.6 points on a 0-100 visual analog scale 3.
- However, 11% to 19% of individuals with endometriosis may not experience pain reduction with hormonal medications, and 25% to 34% may experience recurrent pelvic pain within 12 months of discontinuing treatment 3.