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Continuous estetrol/drospirenone regimen for endometriosis pain: A 6-month study

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Created On: 18/08/2026

Endometriosis, a chronic estrogen-dependent inflammatory disorder, impacts women of reproductive age.

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Key take away

A continuous oral regimen of estetrol (14 mg) and drospirenone (3 mg) alleviates endometriosis-related pelvic pain and reduces endometrioma size over 6 months with a favorable tolerability profile.

Background

Endometriosis, a chronic estrogen-dependent inflammatory disorder, impacts women of reproductive age. Marked by pelvic pain, dyspareunia, and dysmenorrhea, it inflicts a heavy physical and psychological burden. Combined oral contraceptives are first-line conservative management tools designed to induce amenorrhea and suppress ovarian function. However, ethinylestradiol-containing options carry established metabolic and venous thromboembolism risks.

Method

In this retrospective cohort study, 40 patients diagnosed with endometriosis were tracked. Eligible participants were reproductive-aged women experiencing severe symptom burdens, established by a baseline visual analog scale (VAS) pain score exceeding 6. Patients were placed on an uninterrupted daily regimen of 14 mg E4 combined with 3 mg DRSP spanning a total duration of 6 months.

Rather than relying solely on a single post-treatment snapshot, clinical response was monitored dynamically across three key checkpoints: baseline, 3 months, and 6 months. Pain intensity across distinct domains—specifically chronic pelvic pain, dyspareunia, and dysmenorrhea—was mapped using the VAS alongside standardized quality-of-life parameters. In tandem with symptomatic tracking, a sub-cohort of patients presenting with ovarian endometriomas underwent serial ultrasound imaging to quantify changes in lesion volume, while treatment-emergent adverse events were documented throughout to evaluate overall tolerability.

Result

Pain Symptom Control: Continuous E4/DRSP administration attained statistically and clinically significant reductions in both chronic pelvic pain and dyspareunia across the 6-month period.
Dysmenorrhea Suppression: Dysmenorrhea was fully resolved (100% suppression) in all patients, driven by complete amenorrhea induction via the continuous regimen.
Endometrioma Regression: Among those with baseline endometriomas, ultrasound monitoring illustrated an average size reduction of 30% after 6 months of continuous therapy.
Safety & Tolerability: Adverse events were predominantly mild, reported in 32.5% (13/40) of the cohort, with no major treatment-limiting safety signals noted during the study period.

Conclusion

Continuous E4/DRSP (14 mg/3 mg) provided robust pain mitigation, complete dysmenorrhea control, and modest structural reduction of endometriomas over 6 months of therapy. Coupled with a mild adverse event profile and good tolerability, this native estrogen regimen represents a compelling long-term option for conservative endometriosis care.