The effect of dienogest and gonadotropin-releasing hormone agonist on pelvic pain after laparoscopic surgery for endometriosis: An RCT.

Background: Endometriosis is a chronic inflammatory condition associated with debilitating chronic pelvic pain that affects women's quality of life. Several drugs have been used to reduce pain and psychological distress associated with this disease. Currently, gonadotropin-releasing hormone (GnRH) agonists and dienogest are the most widely used medical therapies for endometriosis.

Objective: This study aimed to investigate the efficacy of dienogest and GnRH agonists in improving pelvic pain after laparoscopic surgery for endometriosis.

Materials and methods: In this randomized clinical trial study, 104 women with endometriosis who were referred to the Department of Reproductive Medicine of Yas hospital, Tehran, Iran, between April 2022 and March 2023 were studied. After laparoscopic surgery, individuals were randomly assigned into 2 groups (n = 52/each): the dienogest-administered group and the GnRH agonist-administered group. Participants were followed up at 3 months and pelvic pain was measured using the visual analog scale. Pelvic pain and adverse effects of drugs were compared between the groups.

Results: Pelvic pain significantly improved in both treatment groups (p $<$ 0.0001). No significant difference was observed in hot flashes and joint pain between the dienogest and GnRH agonist groups. However, a significant difference was found in vaginal dryness (p = 0.03) and decreased libido (p = 0.02). GnRH agonists and dienogest reduced irregular vaginal bleeding.

Conclusion: Our results suggested that the effect of GnRH agonists and dienogest in improving pelvic pain for endometriosis is the same after a 3-month treatment period. However, these 2 drugs caused different adverse effects.