Dienogest vs. Combined Oral Contraceptives for Endometriosis Pain: What a 2025 Meta-Analysis Found

Living with endometriosis can mean living with pain that affects your body, your energy, your relationships, and your daily plans. Two commonly used hormonal medication options are dienogest (a progestin) and combined oral contraceptive pills (OCPs). A 2025 systematic review and meta-analysis in BMC Women’s Health compared the short-term effects of these treatments on pain, quality of life, and side effects in women with endometriosis.

Below is a patient-friendly breakdown of what the researchers found—and how you can use this information in a conversation with your clinician.

Why compare dienogest and OCPs?

Both dienogest and oral contraceptive pills (OCPs) are commonly used to help manage endometriosis symptoms, and patients often want to understand how they compare in practical terms. Key questions typically focus on which option is more effective for reducing pain, which leads to greater improvements in overall quality of life, and whether the side-effect profiles differ in meaningful ways that might influence treatment choice. This study aimed to compare them head-to-head using results from randomized controlled trials (RCTs).

What type of study is this—and why that matters

This paper is a systematic review and meta-analysis of randomized controlled trials(RCTs), conducted using PRISMA guidelines. That means the authors:

• • Systematically searched for relevant RCTs
  • Combined results across trials to estimate overall effects

Important note: the findings apply to short-term outcomes. The authors specifically note that long-term data (like recurrence rates or bone-related outcomes) were limited.

Key results: pain relief depends on the type of pain you have

Endometriosis pain isn’t one single experience. The review suggests the “best” option may depend on which pain symptom is most disruptive for you.

Dienogest may help more with “generalized pain” (overall pain on a VAS scale)

Across studies, dienogest showed greater improvement in overall/general pain, measured with a VAS (Visual Analog Scale), compared with OCPs. The meta-analysis reported a statistically significant improvement favoring dienogest (P = 0.001; SMD = −1.46; 95% CI −2.33 to −0.59).

What this could mean for you: If your biggest issue is broad, general endometriosis pain (for example, pain that isn’t only limited to deep pelvic pain or intercourse), dienogest may be a strong option to discuss.

OCPs may help more with pelvic pain and pain during sex (dyspareunia)

The review found dienogest was less effective than OCPs for:

• • Pelvic pain (P = 0.009; SMD = 0.42)
  • Dyspareunia (pain during intercourse) (P = 0.006; SMD = 0.70)

What this could mean for you: If your main symptoms are pelvic painor pain with intercourse, OCPs may offer more relief—based on these short-term RCT findings.

Quality of life: physical and daily-life areas may improve more with dienogest

Quality of life was measured using tools such as EHP-5, EHP-30, and SF-12.

Where dienogest may have an advantage

Compared with OCPs, dienogest significantly improved:

• • EHP-5
  • EHP-30
  • SF-12 Physical Component Summary (PCS)

These measures can reflect how symptoms affect daily functioning (like activity and physical well-being), depending on the questionnaire domain.

Where there was no clear difference

There was no significant difference between dienogest and OCPs for:

• • SF-12 Mental Component Summary (MCS)
  • WHO-QoL scores

What this could mean for you: Dienogest may improve some physical and endometriosis-specific quality-of-life measures more than OCPs, but this meta-analysis did not show a clear short-term difference in overall mental health domains between treatments.

Side effects: mostly similar, but two differences stood out

The review reported no significant difference between dienogest and OCPs in the risk of:

• • Vaginal bleeding
  • Headache
  • Hot flashes
  • Back pain
  • Skin dryness
  • Nausea

However, OCPs were associated with higher risk of:

• • Weight gain
  • Hand numbness

What this could mean for you: If weight change is a major concern for you, or if you have experienced tingling/numbness symptoms before, it may be worth raising these points when discussing OCPs.

Practical takeaways: how to use this evidence in your treatment decision

Because the study suggests benefits differ by symptom type, a “one-size-fits-all” answer isn’t realistic. Consider bringing these questions to your next appointment:

1) “Which pain symptom are we targeting most?”

• • More generalized/overall pain → ask about dienogest
  • More pelvic pain or dyspareunia → ask about OCPs

2) “How will we track if the medication is working?”

Ask what you’ll monitor over the next weeks/months—pain scores, bleeding patterns, daily functioning, or specific quality-of-life measures.

3) “What side effects should make me contact you?”

Since most side effects were similar, it’s still important to have a plan for what to do if you experience bleeding changes, headaches, or other symptoms. Also ask specifically about:

• • Weight changes
  • Numbness/tingling in the hands

What this study cannot tell us (important limitations)

This paper focuses on short-term outcomes. The authors note key gaps, including:

• • Limited evidence on long-term effectiveness
  • Lack of long-term data on outcomes such as recurrence and bone-related changes
  • Differences among the types of OCPs used across trials (meaning not all “OCPs” are identical)

If you’re making a long-term plan, you and your clinician may need additional evidence and ongoing follow-up to decide what fits best.

Bottom line

• • Surgery diagnosis and treatment in these studies: All significant studies reviewed in this analysis noted that endometriosis was biopsy proven but surgery was remote in many (>5 years) and thus synergies with surgical excision were not addressed in this comparison.
  • Dienogest may be better for overall/general endometriosis pain and may improve some physical/endometriosis-specific quality-of-life measures more than OCPs in the short term.
  • OCPs may work better for pelvic pain and pain during intercourse (dyspareunia).
  • Side effects were mostly similar, but OCPs showed higher risk of weight gain and hand numbness in this analysis.
  • The best choice often depends on your main pain pattern, quality-of-life priorities, and side effect concerns—and should be revisited over time.