Dienogest versus Medroxyprogesterone Acetate for Control of Menstrual Pain with Endometriosis

Introduction: Endometriosis is a chronic, estrogen-dependent inflammatory conditions that impacts women in their reproductive age, commonly presenting as pelvic pain, dysmenorrhea, dyspareunia, and infertility. Despite different medical and surgical treatments, managing menstrual pain related to endometriosis remains a clinical challenge. Objectives: The purpose of the study is to compare the effectiveness and safety of the pharmacological intervention by oral Dienogest and Intramuscular depot Medroxyprogesterone acetate for the management of pelvic endometriosis with special reference to reduction of menstrual pain. Methods: This was an observational, prospective, comparative study of 12 months of women age between18 to 45 years attending Gynaecology OPD at RG Kar Medical College and Hospital, Kolkata. Group A(n=40)- received Tab. Dienogest 2mg orally once daily and Group-B(n=40) received Inj. Depot Medroxy Progesterone Acetate 150mg 3 monthly for 6months. The intensity of pain in VAS was calculated at baseline and after 6months of treatments. Results: Dienogest significantly reduced menstrual pain (mean score: 2.2250±.8002) compared to MPA (mean score: 3.7750±.9997), with p<0.0001. Both drugs showed mild side effects; weight gain was slightly higher in MPA users (12.5%) than in Dienogest users (7.5%). Conclusion: Dienogest demonstrated better tolerability, fewer adverse effects, and improved patient satisfaction compared to MPA. But DMPA (Medroxyprogesterone Acetate) is a more cost-effective option with quarterly injections. The study suggests Dienogest as a superior first-line therapy for endometriosis-related pain, but further long-term research is needed.