Dienogest Therapy Against the Combined Oral Contraceptive Pill in Deep Infiltrating Endometriosis Cases: A Systematic Review and Meta-Analysis

Abstract Objectives: Deep endometriosis (DE) is a common disease in 15%–45% of childbearing-age women. Combined oral contraceptive pill (COCP) and dienogest have been used for decades to treat many forms of endometriosis after laparoscopy surgery. This study aims to assess the latest evidence on the effect of dienogest compared with the COCP on the pain scores of dysmenorrhea, dyspareunia, and dyschezia in DE patients. Materials and Methods: Data from 1363 samples of 9 research literature were taken. The postlaparoscopy surgical patients are divided into the dienogest group and the COCP group. The main symptoms were assessed using a visual analog scale for dysmenorrhea, dyspareunia, and dyschezia in addition to the demographic data from patients of the 2 study groups being compared. Results: Seven studies show significant differences in dysmenorrhea scores between the dienogest group and the COCP group. Dyspareunia scores in cases of postoperative endometriosis implants showed 6 studies with lower dyspareunia scores in the dienogest group than the COCP group, while 3 other articles showed higher dyspareunia scores in the dienogest group than in the COCP group. Assessment of the risk of bias in the meta-analysis of the therapeutic effectiveness of the Egger regression test shows nonsignificant results which proves no tendency for publication bias ( t = 1.111; df = 7.00; P = 0.303). Conclusion: Dienogest is an effective pain treatment and it is effective for a subgroup of patients with endometriosis and pelvic pain. It is well tolerated as a pain treatment in adenomyosis patients without complications of severe uterine enlargement or severe anemia.