Dienogest vs. Combined Oral Contraceptive: A Systematic Review and Meta-Analysis of Efficacy and Side Effects to Inform Evidence-Based Guidelines

This systematic review and meta-analysis compared the efficacy and tolerability of dienogest and combined oral contraceptives (COC) for endometriosis treatment. The analysis included four randomized control trials and one observational study. Results showed no significant difference in improving pelvic pain between the two treatments, but dyspareunia was significantly lower in the COC group. There were no statistical differences in side effects such as vaginal bleeding, nausea, headache, hot flushes, and hair loss. The treatment discontinuation rate was similar for both groups. Overall, dienogest and COC are comparable, and the choice of treatment should consider patient preference and clinical history.