Progestins - a review of clinical application in gynecology

AIMS: Progestins are a group of substances with a wide range of applications. They are classified into pregnanes, estranes, and gonanes, and further divided into four generations based on their testosterone (TE) or progesterone (P4) origin. This study reviews the existing literature on the clinical use of progestins. METHODS: A literature review was conducted by PubMed, Google Scholar, Scopus and ClinicalTrials. The following search terms and their combinations were used when reviewing the aforementioned databases: (progestogen OR progestogens OR progestin OR progestins) AND (women OR woman OR men OR man OR adult). The analyzed publications about progestins were dated from 2005 to 2024. RESULTS: Progestins are used in both women and men, either alone (progestin-only contraception, POC) or combined with other substances (combined hormonal contraception, CHC). They are primarily used for contraception but also offer therapeutic benefits for conditions like abnormal uterine bleeding, endometriosis, secondary amenorrhea, infertility, and endometrial hyperplasia. In women with a uterus, balancing progestin with estrogen is crucial to prevent endometrial cancer. Progestins are also used in menopausal hormone therapy (MHT) to alleviate menopausal symptoms and can help prevent premature deliveries. Ongoing clinical trials are exploring their broader potential. CONCLUSIONS: Progestins have diverse therapeutic uses, with promising applications in various diseases. However, off-label use may present legal risks for healthcare providers, highlighting the need for clearer guidelines, particularly in non-gynecological treatments.