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Research · Medication

Progestins for endometriosis and heavy bleeding

Pooled placebo-controlled trials found oral progestins such as dienogest eased endometriosis pain, and dienogest and the medroxyprogesterone injection matched leuprolide with less bone loss. For heavy periods, cyclical progestins cut bleeding less than a hormonal IUD or tranexamic acid. The injection carries an FDA boxed warning for bone loss and a meningioma warning.

Add to Bio HackChecked 2026-11-13
Status
Prescription drugs in the US. The medroxyprogesterone injection Depo-SubQ Provera 104 is FDA-approved for endometriosis-associated pain and to prevent pregnancy, carries a boxed warning for bone loss, and its label advises against use beyond 2 years unless other options are inadequate [1]. Norethindrone acetate tablets are FDA-approved for endometriosis, secondary amenorrhea and abnormal uterine bleeding from hormonal imbalance [2]. Oral medroxyprogesterone acetate (Provera) is FDA-approved for secondary amenorrhea and abnormal uterine bleeding from hormonal imbalance [3]. DailyMed lists dienogest only inside a combined estradiol valerate pill, with no dienogest-only product [4].
Also called
progestin, progestogen, progestagen, progestin-only treatment, dienogest, Visanne, norethindrone acetate, norethisterone acetate, Aygestin, Gallifrey, medroxyprogesterone acetate, MPA, Provera, depot medroxyprogesterone acetate, DMPA, DMPA-SC, Depo-SubQ Provera 104, Depo-Provera, the shot
Taken for
endometriosis pain, period pain from endometriosis, pelvic pain, pain during sex from endometriosis, shrinking endometriomas, heavy periods, irregular bleeding, stopping periods, preventing endometriosis coming back after surgery

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Shown to help3

Reported risks9

What people take it for, and what was found

Shown to help3

StrongStudied in women

Endometriosis pain, compared with placebo

Shown to ease pain in women with endometriosis against placebo, by 2.58 points on a visual analogue pain scale for oral progestins in pooled trials.

Compared with placebo or no treatment, pooled together [5]; placebo [6][7][8]

The numbers and sources
Effect
Against placebo or no treatment, oral progestins lowered overall pain at six months (MD -2.58, 95% CI -3.13 to -2.03, moderate certainty) and period pain at three months (RR 0.21, 95% CI 0.07 to 0.70), while pelvic pain at three months did not differ (RR 0.7, 95% CI 0.29 to 1.69). Quality of life rose (SF-36 MD 4.11, 95% CI 2.41 to 5.82, high certainty) [5]. A network meta-analysis found dienogest superior to placebo for pelvic pain outside periods and for pain during sex [6]. In a 12-week placebo-controlled trial, pain on a 100 mm scale fell 27.4 mm with dienogest 2 mg and 15.1 mm with placebo, a difference of 12.3 mm [7]. In a 24-week trial in China, the difference was 24.54 mm (95% CI 19.15 to 29.93) [8].
Population
8 trials of oral progestins against placebo or no treatment, within a review of 33 trials and 5,059 women with endometriosis confirmed at laparoscopy [5]. 3,259 women in 8 trials [6]. 198 women aged 18 to 45 in Germany, Italy and Ukraine [7]. 255 Chinese women aged 18 to 45 [8].
Sources
[5], [6], [7], [8]
Caveats
The Cochrane comparison pools placebo and no-treatment arms, so it mixes a blinded comparison with an unblinded one [5]. Pain fell 15.1 mm on placebo alone in the 12-week trial [7]. The review notes that few trials report each outcome [5].
ModerateStudied in women

Endometriosis pain, compared with GnRH agonist injections

Shown to ease endometriosis pain in women about as much as GnRH agonist injections such as leuprolide, with less bone loss and fewer hot flushes.

Compared with GnRH agonists [5]; leuprolide injections [9][10][11][1]; a GnRH antagonist [5]

The numbers and sources
Effect
Oral progestins and GnRH agonists did not differ for overall pain (MD -0.01, 95% CI -0.30 to 0.28, low certainty), and side effects overall were more frequent with oral progestins (RR 1.44, 95% CI 1.11 to 1.86). Depot progestins reduced period pain slightly more than GnRH agonists (RR 0.93, 95% CI 0.89 to 0.97, high certainty) with fewer side effects overall (RR 0.03, 95% CI 0.01 to 0.11). Against a GnRH antagonist, more women stopped a depot progestin for side effects (RR 2.02, 95% CI 1.04 to 3.94) [5]. Over 24 weeks, pain fell 47.5 mm with dienogest and 46.0 mm with leuprolide, and spine bone density changed +0.25% against -4.04% [9]. The medroxyprogesterone injection matched leuprolide on four of five pain signs at 6 months and all five at 18 months, with less bone loss [10][11]. Moderate or severe hot flushes at month 6 were reported by 27% on the injection and 69% on leuprolide [1].
Population
10 trials of oral progestins and 2 of depot progestins against GnRH agonists [5]. 252 women [9]. 274 women in Canada and the US [10]. 300 women [11]. Women in the injection's two endometriosis trials [1].
Sources
[5], [9], [10], [11], [1]
Caveats
These are equivalence comparisons between two active drugs, not against placebo. The dienogest trial was open-label [9], and the injection trials blinded only the evaluator [10][11].
LimitedStudied in women

Endometriosis pain: norethindrone acetate compared with dienogest

One small trial found norethindrone acetate 5 mg and dienogest 2 mg eased endometriosis pain in women to a similar degree over 12 months, with fewer dropouts on norethindrone acetate.

Compared with dienogest [13]; dienogest, in consecutive patients before and after a clinic switched drugs [14]

The numbers and sources
Effect
Period pain scores fell from 7.43 and 7.23 to 0 in women completing 12 months on either drug, and pelvic pain scores did not differ significantly. Endometriomas shrank more on norethindrone acetate (p = 0.037). By 6 months, 47.5% on dienogest and 23.3% on norethindrone acetate had dropped out (p = 0.026) [13]. In a clinic that changed its first-choice drug, 71% on norethindrone acetate 2.5 mg and 72% on dienogest were satisfied or very satisfied at 6 months. Treatment was well tolerated by 58% and 80% [14].
Population
70 women aged 18 to 40, 30 on norethindrone acetate and 40 on dienogest, in Turkey [13]. 90 consecutive women on each drug in Italy [14].
Sources
[13], [14]
Caveats
No placebo group. Scores at 12 months come from women who stayed on treatment [13]. The second study was not randomized [14].

Mixed results2

ModerateStudied in women

Endometriosis pain, compared with combined birth control pills

Mixed results: pooled trials found no clear difference in pelvic pain between progestin and combined birth control pills in women with endometriosis. Another review's results varied by pain type.

Compared with combined oral contraceptives [5][12]

The numbers and sources
Effect
Pelvic pain did not differ between oral progestins and combined pills (MD 0.38, 95% CI -0.46 to 1.22, moderate certainty), and side effects overall did not differ (RR 1.13, 95% CI 0.8 to 1.60). Pain-related quality of life was higher with progestins (SF-36 pain MD 11.5, 95% CI 2.35 to 20.65, low certainty) [5]. In another review of 8 trials, dienogest lowered overall pain scores more than a drospirenone pill (SMD -1.66, 95% CI -3.16 to -0.15), but eased pelvic pain (SMD 0.42) and pain during sex (SMD 0.70) less than combined pills. Side effects did not differ, except more hand numbness and weight gain on the pills [12].
Population
Women with endometriosis in 4 trials [5] and 8 trials [12].
Sources
[5], [12]
Caveats
Few small trials, and the certainty for most outcomes was low or very low [5].
ModerateStudied in women

Heavy menstrual bleeding: cyclical progestin tablets

Mixed results: no trial compared cyclical progestins with placebo. Taken for 21 days a cycle, they reduced blood loss in women less than a hormonal IUD, tranexamic acid or ormeloxifene.

Compared with tranexamic acid, danazol and a progesterone-releasing IUD, for short courses [15]; a levonorgestrel IUD, tranexamic acid, ormeloxifene and the combined vaginal ring, for long courses [15]

The numbers and sources
Effect
No trial compared progestins with placebo. Short courses of medroxyprogesterone acetate or norethisterone for 7 to 10 days in the second half of the cycle reduced blood loss less than other medicines (MD 37.29, 95% CI 17.67 to 56.91, 6 trials, 145 women), with more bleeding days. Courses from day 5 to day 26 reduced blood loss less than a levonorgestrel IUD, tranexamic acid or ormeloxifene, and may be similar to the combined vaginal ring (MD 16.88, 95% CI 10.93 to 22.84, 4 trials, 355 women). Breast tenderness and bleeding between periods were more likely with the levonorgestrel IUD [15].
Population
1,071 women with heavy menstrual bleeding in 15 trials [15].
Sources
[15]
Caveats
Most women knew their treatment, and the reviewers rated the evidence low or very low in quality. The abstract gives no units for the blood loss differences [15].

Doses studied

Dienogest trials used 2 mg once daily for 12 weeks [7] or 24 weeks [8][9]. Norethindrone acetate was used at 2.5 mg [14] and 5 mg [13] a day. Its label lists 5 mg a day for endometriosis, increased by 2.5 mg every two weeks to 15 mg a day and held for six to nine months, and 2.5 to 10 mg a day for 5 to 10 days for abnormal bleeding [2]. The injection trials gave 104 mg of medroxyprogesterone acetate under the skin every 3 months for 6 months, against leuprolide 3.75 mg monthly or 11.25 mg every 3 months [10][11]. The injection label gives 104 mg every 12 to 14 weeks [1]. The oral medroxyprogesterone label gives 5 or 10 mg daily for 5 to 10 days for abnormal bleeding [3]. Heavy bleeding trials used medroxyprogesterone acetate or norethisterone for 7 to 10 days from cycle day 15 to 19, or from day 5 to day 26 [15].

Risks

Reported risks8

ModerateStudied in womenVery common

Irregular bleeding and spotting

Shown to cause irregular bleeding more often than leuprolide. The injection label lists irregular bleeding or spotting in 18% of women, its most frequent side effect.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
In the injection's contraception trials, irregular, heavier, lighter or spotting bleeding was reported by 18% and absent periods by 6%. In its endometriosis trials, 24% of 289 women had no period during month 6. Bleeding was the most common reason for stopping (3%) [1]. The injection caused more irregular bleeding than leuprolide [10], and dienogest suppressed bleeding less than leuprolide [9].
Population
2,325 women in five injection trials [1]. 274 women [10]. 252 women [9].
Sources
[1], [10], [9]
Caveats
The label's rates come from trials with no placebo group [1].
LimitedStudied in womenCommon

Weight gain with the injection

The injection label reports a mean gain of 1.6 kg in year one. Women on the injection for 5 years gained 5.1 kg, against 2.9 kg without hormones.

The numbers and sources
How common
Common: between 1 in 100 and 1 in 10 people.
Effect
Increased weight was reported as a side effect by 7% in the contraception trials. Mean gain was 1.6 kg in year one, and 38% gained more than 2.3 kg. After 5 years, 41 women on the 150 mg intramuscular injection had gained 5.1 kg and 114 women using non-hormonal contraception 2.9 kg [1]. Median weight change did not differ from leuprolide over the endometriosis trial [10].
Population
Women in three large injection trials [1]. 155 women in a 5-year comparison [1]. 274 women with endometriosis [10].
Sources
[1], [10]
Caveats
The 5-year comparison was not randomized [1].
LimitedStudied in womenCommon

Depression and mood changes

The injection label reports depression in 3% of women in its trials and warns it may recur or worsen in women with a history of depression.

The numbers and sources
How common
Common: between 1 in 100 and 1 in 10 people.
Effect
In the injection's contraception trials, depression and lower libido were each reported by 3%, and anxiety and irritability by 1% [1]. The norethindrone acetate label advises watching women with a history of clinical depression and stopping the drug if it recurs to a serious degree [2].
Population
2,325 women in five injection trials [1].
Sources
[1], [2]
Caveats
No placebo group, so the share caused by the drug is not known [1].
ModerateStudied in womenHow often is not known

Bone loss with the medroxyprogesterone injection

FDA states, in a boxed warning, that women using the injection may lose significant bone mineral density, more with longer use, and that the loss may not fully reverse.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
On Depo-SubQ Provera 104, spine bone density fell 2.7% (95% CI 2.3 to 3.1) at 1 year and 4.1% (95% CI 3.5 to 4.6) at 2 years, and total hip density 1.7% and 3.5%. After 5 years on the intramuscular injection, spine density was 5.38% lower against 0.43% higher in women using no hormonal contraception, and 2 years after stopping it was still 3.13% lower. In adolescents treated for more than 2 years, hip and femoral neck density had not recovered 5 years after stopping [1]. In 6-month endometriosis trials, bone loss was smaller than with leuprolide and returned to baseline within 12 months of stopping [10][11].
Population
166 women at 1 year and 106 at 2 years [1]. 33 women on the injection and 105 controls at 5 years, 12 and 60 at 7 years [1]. 274 and 300 women with endometriosis [10][11].
Sources
[1], [10], [11]
Caveats
The label states it is unknown whether use in adolescence lowers peak bone mass or raises later fracture risk [1]. Long-term follow-up groups were small.
LimitedStudied in womenHow often is not known

Fractures with the medroxyprogesterone injection

Linked to more fractures in two case-control studies of women using the contraceptive injection, with higher odds after longer use.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
One study found higher fracture odds with any use (OR 1.44, 95% CI 1.01 to 2.06) and with more than four years of use (OR 2.16, 95% CI 1.32 to 3.53). The other found higher odds with past use of one or two prescriptions (OR 1.17, 95% CI 1.07 to 1.29) and with current use of 3 to 9 prescriptions (OR 1.36) or 10 or more (OR 1.54, 95% CI 1.33 to 1.78) [16].
Population
Women in 2 case-control studies, within a review of 14 observational studies [16].
Sources
[16]
Caveats
Observational, with no meta-analysis, so women who chose the injection may differ from those who did not [16]. These were contraceptive users, not women with endometriosis.
LimitedStudied in womenHow often is not known

Meningioma

The injection label warns of meningioma, mainly with long-term use. A French case-control study in women linked prolonged injectable medroxyprogesterone to 5.55 times the odds of meningioma surgery.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
The label states meningiomas have been reported after repeated doses of medroxyprogesterone acetate, mainly with long-term use [1]. Among 18,061 women who had surgery for intracranial meningioma and 90,305 matched controls, injectable medroxyprogesterone was used by 9 cases (0.05%) and 11 controls (0.01%), odds ratio 5.55 (95% CI 2.27 to 13.56), driven by use of one year or more. No excess was found for progesterone, dydrogesterone or levonorgestrel IUDs, and too few women used dienogest to draw conclusions [18].
Population
108,366 women in the French national health database, 2009 to 2018 [18].
Sources
[1], [18]
Caveats
Observational, with few exposed cases, and only meningiomas treated by surgery were counted [18].
ModerateStudied in womenHow often is not known

Venous blood clots

Linked to about 2.7 times the risk of venous blood clots in women using injectable progestin, in observational studies. Progestin-only pills were not linked to a rise.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Across 8 observational studies, progestin-only contraception overall was not linked to venous clots (RR 1.03, 95% CI 0.76 to 1.39), nor were progestin-only pills (RR 0.90, 95% CI 0.57 to 1.45). Injectable progestin was (RR 2.67, 95% CI 1.29 to 5.53) [19]. The injection label reports serious arterial and venous clotting events with the intramuscular form, states that a causal link has not been clearly established, and contraindicates use with current or past clotting disorders [1]. The norethindrone acetate label contraindicates use with active or past deep vein thrombosis or pulmonary embolism and lists clotting events among progestin adverse reactions [2].
Population
147 women with a clot across 8 observational studies [19].
Sources
[19], [1], [2]
Caveats
Few events and observational designs [19]. The studies covered contraceptive doses, not the 5 to 15 mg daily norethindrone acetate doses used for endometriosis [2][19].
LimitedHow often is not known

Use in pregnancy

The norethindrone acetate label contraindicates use in pregnancy, citing reports of mild masculinization of female fetuses and hypospadias after first-trimester exposure.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
The label states several reports suggest an association between progestin exposure in the first trimester and genital abnormalities in male and female fetuses [2]. The injection label advises stopping treatment if pregnancy occurs [1].
Population
Reports summarized on the label [2].
Sources
[2], [1]
Caveats
Reports give no rate.

Mixed results1

LimitedStudied in womenVery common

Bone density with dienogest

Mixed results: over 24 weeks, dienogest left spine bone density unchanged in two trials. In 60 women taking it for a year or more after surgery, spine density fell 2.7%.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
Spine bone density changed +0.25% on dienogest and -4.04% on leuprolide over 24 weeks [9]. In 140 women measured in a placebo-controlled trial, dienogest had no effect on bone density at 24 weeks [8]. After surgery for endometriomas, spine density fell 2.2% at 6 months and 2.7% at 1 year on dienogest, femoral neck density fell 2.8% at 1 year, and 45 of 60 women (75%) had a significant fall. Density did not fall further in the second year in 24 women [17].
Population
252 women [9]. 140 women [8]. 60 women aged about 30 after surgery, treated for a mean of 18.6 months [17].
Sources
[9], [8], [17]
Caveats
The longer study had no control group [17].

Checked, no increase found1

ModerateStudied in women

Side effects overall, compared with placebo

Not shown to raise side effects overall, or stopping for side effects, against placebo in pooled trials of oral progestins in women with endometriosis.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Side effects overall (RR 1.18, 95% CI 0.94 to 1.46) and withdrawals for side effects (RR 2.36, 95% CI 0.74 to 7.52) did not differ significantly from placebo, at moderate certainty [5]. A network meta-analysis found dienogest had the fewest adverse effects among dienogest, GnRH agonists and GnRH antagonists [6]. In one clinic, 58% tolerated norethindrone acetate well and 80% dienogest [14].
Population
Women in 8 placebo or no-treatment trials [5]. 3,259 women [6]. 180 women [14].
Sources
[5], [6], [14]
Caveats
The confidence interval for withdrawals is wide and includes a doubling [5].

Possible, not studied in people1

Untested

Drugs that speed its breakdown

Not studied in people. The injection label predicts that strong liver enzyme inducers such as rifampin, carbamazepine and St. John's wort may lower its levels.

No study in people. This rests on how it acts in the body.

The numbers and sources
Effect
The label states that moderate or strong CYP3A inducers, including rifampin, carbamazepine, phenytoin, phenobarbital, efavirenz, modafinil and St. John's wort, may lower medroxyprogesterone acetate levels and its effect, a prediction from how the drug is broken down that was not confirmed in a clinical study [1].
Population
No people studied; a regulator's prediction from metabolism [1].
Sources
[1]
Caveats
Predicted, not observed.

Claims tested and not found

  1. That dienogest eases endometriosis pain more than norethindrone acetate. In a randomized trial, pain scores did not differ between the two [13], and satisfaction was 71% and 72% before and after one clinic switched drugs [14].
  2. That progestin pills ease endometriosis pain less than GnRH agonist injections. Overall pain did not differ in pooled trials (MD -0.01, 95% CI -0.30 to 0.28) [5], and pain fell 47.5 mm on dienogest and 46.0 mm on leuprolide over 24 weeks [9].

Related

Hormonal birth controlGnRH drugs for fibroidsNSAIDsTranexamic acidProgesteroneEndometriosis surgery

Sources

  1. Depo-SubQ Provera 104 (medroxyprogesterone acetate) injectable suspension, prescribing information. DailyMed, US National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=390087a6-f3c3-4f0b-a930-79acf412f153
  2. Norethindrone acetate tablets, prescribing information (Glenmark). DailyMed, US National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d0a94321-eb60-4aa6-a429-f0156f9f8e01
  3. Provera (medroxyprogesterone acetate) tablets, prescribing information. DailyMed, US National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a586be28-96af-4fed-a13f-9b94fd4c7405
  4. Natazia (estradiol valerate and estradiol valerate/dienogest) tablets, prescribing information. DailyMed, US National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=3fbcd7d8-cc53-4dbb-8edc-451acadc472c
  5. Chen I, Kives S, Zakhari A, et al. Progestagens for pain symptoms associated with endometriosis. Cochrane Database of Systematic Reviews. 2025. https://doi.org/10.1002/14651858.cd002122.pub3
  6. Dick A, Matok I, Gutman-Ido E, Lessans N, Dior UP. GnRH analogues and dienogest for second line treatment of endometriosis-associated pain: a systematic review, meta-analysis, and network meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2025. https://doi.org/10.1016/j.ejogrb.2025.114093
  7. Strowitzki T, Faustmann T, Gerlinger C, Seitz C. Dienogest in the treatment of endometriosis-associated pelvic pain: a 12-week, randomized, double-blind, placebo-controlled study. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2010. https://doi.org/10.1016/j.ejogrb.2010.04.002
  8. Lang J, Yu Q, Zhang S, et al. Dienogest for Treatment of Endometriosis in Chinese Women: A Placebo-Controlled, Randomized, Double-Blind Phase 3 Study. Journal of Women's Health. 2018. https://doi.org/10.1089/jwh.2017.6399
  9. Strowitzki T, Marr J, Gerlinger C, Faustmann T, Seitz C. Dienogest is as effective as leuprolide acetate in treating the painful symptoms of endometriosis: a 24-week, randomized, multicentre, open-label trial. Human Reproduction. 2010. https://doi.org/10.1093/humrep/dep469
  10. Schlaff WD, Carson SA, Luciano A, Ross D, Bergqvist A. Subcutaneous injection of depot medroxyprogesterone acetate compared with leuprolide acetate in the treatment of endometriosis-associated pain. Fertility and Sterility. 2006. https://doi.org/10.1016/j.fertnstert.2005.07.1315
  11. Crosignani PG, Luciano A, Ray A, Bergqvist A. Subcutaneous depot medroxyprogesterone acetate versus leuprolide acetate in the treatment of endometriosis-associated pain. Human Reproduction. 2006. https://doi.org/10.1093/humrep/dei290
  12. Gu Y, Shi Y, Bi B, Jiang Y, Ruan F. Comparison of the short-term effects of dienogest and oral contraceptives on pain and quality of life in women with endometriosis: a systematic review and meta-analysis. BMC Women's Health. 2025. https://doi.org/10.1186/s12905-025-03985-9
  13. Gurbuz TB, Aslan K, Kasapoglu I, Muzii L, Uncu G. Norethindrone acetate versus dienogest for pain relief in endometriosis related pain: A randomized controlled trial. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2025. https://doi.org/10.1016/j.ejogrb.2025.113940
  14. Vercellini P, Bracco B, Mosconi P, et al. Norethindrone acetate or dienogest for the treatment of symptomatic endometriosis: a before and after study. Fertility and Sterility. 2016. https://doi.org/10.1016/j.fertnstert.2015.11.016
  15. Bofill Rodriguez M, Lethaby A, Low C, Cameron IT. Cyclical progestogens for heavy menstrual bleeding. Cochrane Database of Systematic Reviews. 2019. https://doi.org/10.1002/14651858.cd001016.pub3
  16. Lopez LM, Chen M, Mullins Long S, Curtis KM, Helmerhorst FM. Steroidal contraceptives and bone fractures in women: evidence from observational studies. Cochrane Database of Systematic Reviews. 2015. https://doi.org/10.1002/14651858.cd009849.pub3
  17. Seo JW, Lee DY, Yoon BK, Choi D. Effects of long-term postoperative dienogest use for treatment of endometriosis on bone mineral density. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2017. https://doi.org/10.1016/j.ejogrb.2017.03.011
  18. Roland N, Neumann A, Hoisnard L, et al. Use of progestogens and the risk of intracranial meningioma: national case-control study. BMJ. 2024. https://doi.org/10.1136/bmj-2023-078078
  19. Mantha S, Karp R, Raghavan V, et al. Assessing the risk of venous thromboembolic events in women taking progestin-only contraception: a meta-analysis. BMJ. 2012. https://doi.org/10.1136/bmj.e4944

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