Bushra Bahar, Neena Gupta, Alok Raghav, Uruj Jahan, Rashmi Yadav
Both treatments were associated with significant improvement in endometriosis-associated pain, and the OCP group showed greater short-term pain reduction in this cohort, suggesting that the evaluated levonorgestrel/ethinyl estradiol regimen may represent a conservative treatment option, particularly in resource-limited healthcare settings. Larger multicenter longitudinal studies are warranted to further validate these findings.
OBJECTIVE: To compare the clinical effectiveness of combined oral contraceptive pills (levonorgestrel-containing COC) and dienogest in the management of endometriosis-associated chronic pelvic pain and related symptoms.
METHODS: This prospective observational cohort study was conducted in the Department of Obstetrics and Gynecology at GSVM Medical College, Kanpur, India, between 2023 and 2024. A total of 140 women with clinically and ultrasonographically diagnosed endometriosis-associated pelvic pain completed the study and were included in the final analysis. Participants received either dienogest (2 mg once daily) or a continuous combined oral contraceptive containing ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg for 3 months. Pain severity was assessed using the Visual Analog Scale (VAS) at baseline and during monthly follow-up visits. Longitudinal changes in pain scores and associated symptoms were compared between the treatment groups.
RESULTS: Baseline demographic and clinical characteristics were comparable between the groups. The mean age of participants in the OCP and dienogest groups was 31.47 ± 8.90 and 31.08 ± 8.78 years, respectively (p=0.794). Baseline mean VAS scores were 8.55 ± 0.98 and 7.77 ± 0.90 in the OCP and dienogest groups, respectively. A significant reduction in VAS scores was observed in both groups throughout the follow-up period (p<0.001). At 3 months, the mean VAS score decreased to 4.28 ± 1.15 and 5.22 ± 1.66 in the OCP and dienogest groups, respectively (p<0.001). Significant improvement in dysmenorrhea, dyspareunia, menstrual irregularities, and chronic pelvic pain was also observed in both groups during follow-up.
CONCLUSION: Both treatments were associated with significant improvement in endometriosis-associated pain, and the OCP group showed greater short-term pain reduction in this cohort, suggesting that the evaluated levonorgestrel/ethinyl estradiol regimen may represent a conservative treatment option, particularly in resource-limited healthcare settings. Larger multicenter longitudinal studies are warranted to further validate these findings.