Dienogest for endometriosis (3–6 months): a systematic review and meta-analysis

Background. Endometriosis affects ~10% of women of reproductive age, with pelvic pain as its leading manifestation. Dienogest 2 mg/day is an approved first-line progestin; early (3–6 month) response drives adherence.

Objective. To quantitatively assess the efficacy of dienogest 2 mg/day for endometriosis-associated pain and its tolerability in short-term (3–6 month) studies.

Methods. Systematic PubMed search (411 records); eligible RCTs and prospective single-arm before–after studies of dienogest 2 mg/day monotherapy with pain assessment at 3–6 months. Pain harmonised to a 0–10 scale; random-effects pooling (DerSimonian–Laird, Knapp–Hartung); tolerability pooled as proportions.

Results. 27 studies entered the pain synthesis. Pooled pain reduction: overall pelvic pain −3.64 (95% CI −4.46 to −2.82; k=17), dysmenorrhoea −3.82 (−4.67 to −2.98; k=14), dyspareunia −1.93 (−3.09 to −0.78; k=10). Discontinuation any cause 11.2% (8.1–15.2; k=29); due to adverse events 6% (4.9–8.0; k=22).

Conclusions. Over 3–6 months dienogest 2 mg/day yields a clinically meaningful reduction in pelvic pain and dysmenorrhoea with favourable tolerability, supporting first-line use from treatment start.