Dienogest vs. GnRH analogues for endometriosis-related pelvic discomfort

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Created On: 09/05/2025

This systematic review and meta-analysis was carried out to compare the effectiveness of Dienogest (fourth-generation progestin) versus gonadotropin-releasing hormone (GnRH) analogues in alleviating endometriosis-driven pelvic pain.

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Key take away

Dienogest shows comparable efficacy to GnRH analogues in alleviating endometriosis-related pelvic pain while exhibiting a more favorable safety profile with fewer adverse events.

Background

Method

A comprehensive search was executed using Google Scholar and PubMed. Randomized controlled trials (RCTs) investigating the efficacy of Dienogest compared to GnRH analogues for Pelvic discomfort due to endometriosis were included. Data extraction followed a structured checklist. RevMan 5 software was utilized to pool and analyze the mean visual analog scale (VAS) scores and reported adverse events from the selected studies. A random-effects model facilitated comparisons between the Dienogest and GnRH analogue groups. The effectiveness of Dienogest versus GnRH analogues in pain reduction was the primary outcome while the incidence of adverse events was the secondary outcome.

Result

Out of 517 initial records, 106 underwent full-text evaluation, with 4 studies comprising a total of 770 patients meeting inclusion criteria. Dienogest was equally effective as GnRH analogues in ameliorating endometriosis-related pain (Odds ratio = 0.97). The Q statistic indicated no heterogeneity (I² = 0%). Furthermore, Dienogest was linked with fewer adverse events as opposed to GnRH analogues (Odds ratio = 0.05), though heterogeneity was high (I² = 95%).

Conclusion

Dienogest offered pain relief comparable to GnRH analogues while demonstrating a more favorable safety profile with fewer adverse effects. These findings reinforced Dienogest as a valuable therapeutic option for endometriosis-associated pain management.