**7. Progestogens**

Regarding progestogens, a prospective observational cohort study found that medication therapy for women with heavy menstrual bleeding can be successfully implemented at primary care centers, with a low rate of surgery, in conjunction with an improvement in their quality of life [11].

Menorrhagia is a common indication for hysterectomy. Adenomyosis and endometriosis are common causes of menorrhagia and pelvic pain in women of reproductive age; therefore, progestogens could be considered as an alternative to hysterectomy.

In this context, a study aimed at evaluating the effects of etonogestrel implants on pelvic pain and menorrhagia in patients that had not completed their families, thus requiring long-acting reversible contraception and being sufferers from adenomyosis or endometriosis. One hundred women with adenomyosis or endometriosis received etonogestrel implants and were followed-up for 24months. Of these, 74 women completed the 24-month follow-up. There was a significant decrease in pelvic pain and menstrual blood loss [12].

It was concluded that etonogestrel implants were effective in reducing pelvic pain and menstrual flow in women with adenomyosis or endometriosis [12].
