Dienogest vs continuous oral levonorgestrel/ Ethinyl Estradiol in patients with endometriosis: what's the best choice?

Combined oral contraceptives (COC) and progestogens are widely used for the treatment of endometriosis.

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This study was carried out to compare the effect of dienogest (2mg) vs a combined oral contraceptive (levonorgestrel 0.1mg/ethinyl estradiol 0.02mg) on ovarian endometriomas, deep infiltrating endometriosis (DIE), chronic pelvic pain (CPP), dyspareunia, pain relief, quality of life and the potential side effects.

Both treatments are effective and safe for patients with endometriosis. Patient’s compliance and side effects are similar in both groups;

However, there was a significantly higher reduction in endometriotic lesions, pain symptoms, and improvement of the quality of life in women taking dienogest than in women taking continuous combined oral contraceptives.

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Objective: The objective of the study is to compare the efficacy of dienogest 2 mg vs continuous oral levonorgestrel/EE (levonorgestrel 0.1 mg/ethinyl estradiol 0.02 mg) on ovarian endometriomas, deep infiltrating endometriosis (DIE), chronic pelvic pain (CPP), dyspareunia, analgesic use, quality of life (QoL), compliance and side effects.

Methods: Prospective cohort study. Two cohorts of patients with endometriosis, 50 taking dienogest (group A) and 50 taking continuous levonorgestrel/EE (group B), were evaluated at the beginning of therapy (t0), after 3 (t3) and 6 months (t6). Size of endometriomas, DIE, QoL, pain symptoms, and side effects were assessed.

Results: Dienogest was significantly effective on CPP, dyspareunia ovarian endometriomas and DIE lesions reduction. Levonorgestrel/EE was significantly effective on dyspareunia. Analgesics consumption significantly decreased in both groups. Both treatments significantly improved the QoL. Over 6 months a significant improvement was found, more frequently in patients taking dienogest. The only side effect that both groups complained about was vaginal bleeding, present in the first 3 months of treatment.

Conclusions: Both treatments are effective and safe for patients with endometriosis. Patient’s compliance and side effects are similar in both groups; however, there was a significantly higher reduction in endometriotic lesions, pain symptoms, and improvement of the QoL in women taking dienogest than in women taking continuous COC.

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https://pubmed.ncbi.nlm.nih.gov/33650928/
https://fertilityscience.org/dienogest-vs-levonorgestrel-ethinyl-estradiol-for-endometriosis/

This is for informational purposes only. You should consult your clinical textbook for advising your patients.