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The following is a summary of “Comparative study on the effects of combined oral contraceptives and dienogest in women with endometriosis‑associated chronic pelvic pain,” published in the November 2024 issue of Obstetrics and Gynecology by Caruso et al. 

Researchers conducted a study to compare the effectiveness of 5 combined oral contraceptives (COCs) – ethinylestradiol (EE) 30 μg/ dienogest (DNG) 2 mg, EE 20 μg/ drospirenone (DRSP) 3 mg, 17β-estradiol (E2) 1.5 mg/ nomegestrol acetate (NomAc) 2.5 mg, estetrol (E4) 15 mg/DRSP 3 mg, and estradiol valerate (E2V) /DNG – and DNG 2 mg daily in women with endometriosis-associated chronic pelvic pain (CPP), dysmenorrhea, and dyspareunia.  

They performed the study between October 2018 and March 2023, setting up a database to collect data from women across 6 treatment groups. The level of endometriotic pain was assessed using a visual analog scale (VAS) with follow-up assessments at 3 and 6 months.  

The results showed an improvement in the VAS score from baseline to 6-month follow-up for each treatment group (P < 0.001). The Intergroup analysis revealed that women on COCs containing E2 or E4 had a greater improvement in CCP compared to those on COCs containing EE (3 months, P ≤ 0.001; 6 months, P ≤ 0.009). Women on E4 15 mg/DRSP 3 mg showed similar improvements to those on DNG at both 3 and 6 months, with greater improvement than women on COCs containing E2 at 6 months (P = 0.02). Greater reductions in dysmenorrhea and dyspareunia were observed in women on COCs with E2, E4, and DNG compared to those on COCs containing EE (P ≤ 0.001).  

Investigators concluded the COCs containing E2 or E4 may be more effective for endometriosis-associated pain than EE-based COCs and could be a suitable alternative to DNG for women seeking non-contraceptive use. 

Source: ejog.org/article/S0301-2115(24)00621-3/abstract