Clinical effectiveness of progestogens compared to combined oral contraceptive pills in the treatment of endometriosis: A systematic review and meta-analysis

OBJECTIVE: Endometriosis involves the growth of endometrium-like cells outside the uterus, affecting reproductive-aged women. Symptoms such as dysmenorrhea, pelvic pain, and infertility significantly impair quality of life. Among therapeutic options, progestogens have demonstrated efficacy in managing pain and reducing recurrence rates. This study aimed to compare the clinical effectiveness of progestogens versus combined oral contraceptive pills in alleviating pelvic pain, dyspareunia, dysmenorrhea, and associated side effects. STUDY DESIGN: A systematic review and meta-analysis were conducted by searching PubMed, Embase, and the Cochrane Central Register of Controlled Trials, with the last search conducted in October 2024. The review was registered under PROSPERO registration number CRD42024609658. Studies were included regardless of language, publication year, or country. Articles not comparing progestogens and combined oral contraceptives or lacking relevant outcomes were excluded, as were abstracts, theses, case reports, opinion pieces, and correspondence. Risk of bias was assessed using the modified Cochrane Risk of Bias tool 2.0 for randomized studies. RESULTS: Seven studies, including 948 patients (476 receiving progestogens), met inclusion criteria. The meta-analysis found no significant differences between progestogens and COCPs for pelvic pain (SMD = 0.02; 95 % CI: -0.37 to 0.40; P = 0.04; I2 = 66.7 %), dysmenorrhea (SMD = 0.00; 95 % CI: -0.19 to 0.19), dyspareunia (SMD = 0.21; 95 % CI: -0.42 to 0.85; P = 0.02; I2 = 81.4 %), or psychological health (SMD = 0.01; 95 % CI: -0.21 to 0.23; P = 0.19; I2 = 39.1 %). Similarly, no significant differences were observed in side effects, including breast tenderness, weight gain, amenorrhea, and bleeding. CONCLUSION: Progestogens and COCPs demonstrate comparable efficacy in managing pelvic pain, dysmenorrhea, dyspareunia, and psychological health, with similar side effect profiles. These findings suggest both treatments are equally effective options for symptom management in endometriosis.