Comparative study on the effects of combined oral contraceptives and dienogest in women with endometriosis‑associated chronic pelvic pain.

Abstract

To compare the effects of five combined oral contraceptives (COCs) - ethinylestradiol (EE) 30μg/dienogest (DNG) 2mg, EE 20μg/drospirenone (DRSP) 3mg, 17β-estradiol (E2) 1.5mg/nomegestrol acetate (NomAc) 2.5mg,estetrol (E4) 15mg/DRSP 3mg and estradiol valerate (E2V)/DNG - and DNG 2mg daily in women with endometriosis-associated chronic pelvic pain (CPP), dysmenorrhea and dyspareunia. This study was performed from October 2018 to March 2023. A database was set up to collect data from women in each of the six treatment groups. The level of endometriotic pain was measured using a visual analogue scale (VAS). Follow-up was performed at 3 and 6months. The intragroup analysis showed an improvement in the VAS score from baseline to 6-month follow-up for each group (p<0.001). Intergroup analysis showed that women on COCs containing E2 or E4 had a greater improvement in CCP than women on COCs containing EE (at 3months, p≤0.001; at 6months, p≤0.009). Women on E4 15mg/DRSP 3mg showed a similar improvement to women on DNG at both 3- and 6-month follow-up, and greater improvement compared with women on COCs containing E2 at 6-month follow-up (p=0.02). Greater improvement in dysmenorrhea and dyspareunia was seen in women on COCs containing E2 and E4, and DNG compared with women on COCs containing EE (p≤0.001). COCs containing E2 or E4 could be a better treatment for women with endometriosis-associated pain than COCs containing EE. They may represent a suitable alternative to the use of DNG, particularly for women who do not want to become pregnant.