Endometriosis associated pain is a major concern in women's healthcare. GnRH agonists and dienogest are well established treatments for pain symptoms. Recently, oral GnRH antagonists were introduced and shown to be effective for endometriosis treatment. Yet, superiority of either of those drugs is not yet known. This meta-analysis aimed to compare the efficacy and side effect profile of GnRH analogues and Dienogest for the treatment of endometriosis associated pain

Design: MEDLINE, Embase, and Cochrane were searched for randomized controlled trials evaluating the impact of Dienogest and GnRH analogues on pelvic pain, dysmenorrhea and dyspareunia

Setting: Systemic review and meta-analysis

Patients or Participants: women with surgically confirmed endometriosis suffering from pelvic pain, dysmenorrhea and dyspareunia

Interventions: none

Measurements and Main Results: Relative risks were calculated with subsequent 95% confidence intervals. Network meta-analysis was conducted, incorporating direct and indirect comparisons among the different treatments. The primary outcome was significant (>30%) reduction in endometriosis associated pain.

Results: 8 studies including 2,967 patients reported percentile of women with a significant improvement in pelvic pain. Dienogest was found to be superior to GnRH antagonist treatment (RR 1.42, CI 1.04- 1.02) and to Leuprolide (RR 1.46, C.I. 1.04-2.06). Six studies including 2,255 patients reported upon improvement is dysmenorrhea. High dose (>200 mg/day) of GNRH antagonist was found to be superior to low dose (<150 mg/day) GNRH antagonist (RR 1.61, C.I. 1.3-2.0) and to Leuprolide (RR 1.43, C.I. 1.1-1.86).

Conclusion: Dienogest has shown to be more effective in improving pelvic pain, as compared to the other drugs. Likewise, high dose GNRH-antagonist is beneficial in the treatment of dysmenorrhea. These finding may serve clinical practitioners in electing medical therapy