Medical Management of Endometriosis-Associated Pain: Dienogest Versus Levonorgestrel IUD

Abstract

Introduction: Endometriosis affects 10% of reproductive-age women. First-line hormonal options include oral dienogest (progestin) and levonorgestrel-releasing intrauterine device (LNG-IUD). Head-to-head comparisons are limited. Methods: Systematic review of 7 RCTs (n=1,045) comparing dienogest 2mg daily versus LNG-IUD 52mg over 12 months. Primary outcome: reduction in dysmenorrhea (VAS 0-10). Secondary: non-cyclic pelvic pain, dyspareunia, bleeding profile, discontinuation rate. Results: Dysmenorrhea reduction was similar (mean VAS change: dienogest -5.2, LNG-IUD -5.0, p=0.64). Non-cyclic pelvic pain and dyspareunia also similar. LNG-IUD had higher rates of irregular bleeding (52% vs 38% at 3 months, p=0.02) but lower systemic side effects (mood changes: 12% vs 28%, p<0.001). Discontinuation by 12 months: 22% (dienogest) vs 19% (LNG-IUD), p=0.31. Discussion: Both are effective, but side effect profiles differ. Dienogest causes more mood-related complaints; LNG-IUD causes more initial bleeding. Conclusion: Patient preference should guide choice. LNG-IUD may be better for those desiring long-term contraception.