Hormonal medicines that prevent pregnancy are also studied as ways to reduce period pain, heavy bleeding and the pelvic pain linked to endometriosis and adenomyosis. This article describes what randomized trials and systematic reviews have reported about combined hormonal contraceptives, progestin-only methods, levonorgestrel intrauterine systems and gonadotropin-releasing hormone (GnRH) therapies. In many placebo-controlled trials the treated groups reported more pain relief or lighter bleeding than the comparison groups [4][8][13], and the same trials reported side effects such as irregular bleeding, hot flushes and, with some GnRH drugs, bone density loss [7][8][13]. Trials are mostly short, often funded by manufacturers, and use many different outcome measures, so comparisons between methods are limited [5][7][38]. Guidelines describe the options and advise individual decision-making [1][3]. This article does not recommend any option.

Key points

  • In reviews of placebo-controlled trials, combined oral contraceptives were associated with lower menstrual pain scores in primary dysmenorrhea (21 trials, 3,723 women), but the evidence for endometriosis pain was rated very low certainty because only a few small trials with high risk of bias were available [4][8].
  • Oral progestagens were associated with lower overall endometriosis pain than placebo with moderate certainty in a 2025 Cochrane review of 33 trials, while head-to-head comparisons with other hormones were mostly low certainty [5].
  • Oral GnRH antagonist trials of 3 to 6 months reported higher pain responder rates than placebo; follow-up beyond 6 months came mainly from extension studies, one of which was open-label with 37% early termination, and bone density loss was a recurring safety outcome [13][14][15].
  • For heavy menstrual bleeding, a Cochrane overview ranked the levonorgestrel intrauterine system first for reducing blood loss, but the certainty was low and satisfaction results were very low certainty [11].
  • Side effects differ by method and are counted differently by trial. Irregular bleeding is common with contraceptive and progestin methods, and it was the main reason given for stopping in one systematic review [8][19][22][35].
  • Reasons for stopping, dropout rates and long-term follow-up are reported inconsistently, and in a 10-year follow-up of a bleeding trial, 43% of respondents had stopped all medical treatment between years 5 and 10 [30].
  • Trials define pain, bleeding and quality of life in many ways, and researchers have called for agreed core outcome sets [37][38][39].
Two hands holding a clipboard with a printed monthly calendar page against a pale wall
Brooke Lark (Unsplash), via Wikimedia Commons · CC0 1.0 Universal public domain dedication, confirmed on the Wikimedia Commons file page · Image source

What the terms mean in this research

"Hormonal contraception" covers pills, patches and rings that combine an estrogen and a progestin, progestin-only pills, injections and implants, and intrauterine systems that release a progestin [5][12][42]. In research on pelvic pain and bleeding, these products are studied for reasons other than pregnancy prevention, as the review titles show: "for pain associated with endometriosis," "for primary dysmenorrhoea," "for heavy menstrual bleeding" [4][8][9].

"Menstrual suppression" means reducing or stopping bleeding, either by taking active hormone pills without a break (continuous or extended regimens) or by using a method that thins the uterine lining [12][36]. A narrative review of endometriosis treatment states that hormonal drugs suppress ovulation and menstruation and that medical therapies control symptoms but do not cure the disease [36].

GnRH-based therapies work differently. They reduce ovarian estrogen production [13]. Trials report hot flushes and bone density loss with these drugs [7][13], so many add an estrogen and a progestin, called "add-back therapy" or "combination therapy" [14][17]. Oral GnRH antagonists include elagolix, relugolix and linzagolix [13][17].

What the studies measured: pain, bleeding and quality of life

Trials of endometriosis treatment usually report pain in separate categories. The ones most often named are dysmenorrhea (period pain), non-menstrual pelvic pain and dyspareunia (pain with sex) [13]. A systematic review of 258 treatment studies found that the visual analog scale was the most frequently used pain scale, and that of the scales with a published "minimal clinically important difference," only the visual analog scale had been studied in people with endometriosis, with a difference of 10 mm on a 100 mm line proposed [37].

Several recent drug trials use a "responder" outcome instead. In the elagolix trials, a responder was a participant with a clinically meaningful reduction in an electronic diary pain score and a stable or lower use of rescue pain medicine [13].

Bleeding is measured with blood loss assays in some trials, with pictorial charts or diaries in others, and with the proportion of people who report amenorrhea (no bleeding) in others [9][26][35]. The Cochrane review of intrauterine systems for heavy bleeding reports blood loss by two different methods in different trials [9].

Quality of life is measured with the Endometriosis Health Profile-30 (EHP-30), the 36-item Short-Form Health Survey (SF-36) or the Menorrhagia Multi-Attribute Scale, depending on the trial [9][16][24].

A single eucalyptus stem with rounded gray-green leaves against a soft dark background
Annie Spratt (Unsplash), via Wikimedia Commons · CC0 1.0 Universal public domain dedication, confirmed on the Wikimedia Commons file page · Image source

Combined hormonal contraceptives

Primary dysmenorrhea

A 2023 Cochrane review of combined oral contraceptive pills for primary dysmenorrhea, meaning period pain without pelvic disease found by examination or ultrasound, included 21 randomized trials with 3,723 women [8]. Compared with placebo or no treatment, the pill was associated with a moderate reduction in pain (standardized mean difference -0.58, based on 6 trials and 588 women, high-quality evidence) [8]. The review reported that pills probably raised the risk of any adverse event (risk ratio 1.31), and raised the risk of irregular bleeding (risk ratio 2.63, high-quality evidence), headache and nausea [8]. The authors state that long-term effects were not covered [8]. Low-quality evidence from two trials with 106 women suggested that continuous use may reduce pain more than the standard regimen [8].

Endometriosis pain

The Cochrane review of oral contraceptives for endometriosis pain, searched through October 2017, included five trials with 612 women, but only three trials with 404 women provided usable data [4]. Two trials compared the pill with placebo, were judged at high risk of bias, and showed lower dysmenorrhea scores in the pill group, with very low-quality evidence [4]. The review noted substantial involvement of the pharmaceutical company funding the trials [4]. The authors concluded there was insufficient evidence to judge effectiveness [4].

One of the placebo-controlled trials was done in Japan with 100 patients who had dysmenorrhea associated with endometriosis; most had imaging rather than surgical evidence of endometriosis [20]. After four treatment cycles, dysmenorrhea scores were lower in the pill group than in the placebo group, and the volume of endometriomas larger than 3 cm decreased in the pill group but not in the placebo group [20].

A later trial in 312 patients compared a flexible extended regimen of ethinylestradiol with drospirenone against placebo for 24 weeks, followed by a 28-week open-label extension with an unblinded dienogest arm for reference [23]. The mean difference in the most severe pelvic pain score, on a visual analog scale measured in millimeters, was -26.3 mm compared with placebo [23].

Extended and continuous regimens

The Cochrane review of continuous or extended-cycle versus cyclic use of combined hormonal contraceptives for contraception included 12 randomized trials [12]. Pregnancy rates and safety profiles were similar across regimens, and participants in the extended or continuous group reported fewer headaches, bloating and menstrual pain in studies that measured menstrual symptoms [12]. The authors could not pool the data, because the trials used different hormones and different lengths of continuous dosing [12]. A 2026 systematic review of 18 randomized trials and 10 other studies reported similar contraceptive effectiveness, fewer total bleeding or spotting days in some trials, and more unscheduled bleeding [34]. It cautioned that acceptability and bleeding results should be read in light of higher discontinuation rates and missing outcome data [34].

These two reviews studied contraception, so their primary outcome was pregnancy prevention, not pain.

Progestin-only methods

Oral and depot progestagens in endometriosis

The 2025 Cochrane review of progestagens for endometriosis pain included 33 randomized trials with 5,059 participants with laparoscopically diagnosed endometriosis; 13 studies were at overall low risk of bias [5]. Compared with placebo or no treatment (8 studies), oral progestagens probably reduced overall pain on a visual analog scale (moderate certainty) and probably reduced dysmenorrhea at three months (moderate certainty), but they may have made little or no difference to pelvic pain at three months (low certainty) [5]. Withdrawal due to adverse effects was probably similar to placebo (moderate certainty) [5].

Compared with oral contraceptives (4 studies), oral progestagens probably made little or no difference to pelvic pain (moderate certainty), and several other outcomes were low or very low certainty [5]. Compared with GnRH agonists (10 studies), oral progestagens may have made little or no difference to overall pain (low certainty), and cumulative side effects were probably higher with oral progestagens (moderate certainty) [5].

The Japanese randomized trial comparing dienogest with intranasal buserelin, a GnRH agonist, in 271 patients over 24 weeks found that dienogest reduced symptom scores at the end of treatment, with changes comparable to buserelin for most symptoms [19]. Dienogest was associated with more frequent irregular genital bleeding and fewer hot flushes, and bone mineral density fell less than with buserelin [19].

In a placebo-controlled trial of dienogest in 255 Chinese women, the mean reduction in pelvic pain on a 100 mm scale was 24.5 mm greater than with placebo at week 24, and bone mineral density was unchanged in a subset of 140 women [21]. An open-label extension then gave dienogest to 220 women who had completed that trial for up to 28 more weeks, and mean pain scores at the end were 40 to 43 mm below baseline [22]. Bleeding frequency and intensity decreased during continued treatment, after longer spotting or bleeding episodes at the start [22].

Progestins in adenomyosis

For adenomyosis, randomized trials are fewer and smaller. A placebo-controlled trial in Japan enrolled 67 patients with adenomyosis and compared dienogest with placebo for 16 weeks; pain scores fell more with dienogest, and almost all treated patients reported irregular uterine bleeding [28]. A single-center open-label trial in India compared a levonorgestrel intrauterine system with dienogest over 12 weeks and found pain scores fell in both groups [27]. The proportion reporting lighter bleeding was 90% (27 of 30) with the intrauterine system and 77% (17 of 22) with dienogest, while a quality-of-life scale improved more in the dienogest group [27]. These are short trials with small samples.

A small copper-colored pocket diary, a silver pen and a binder clip on a pale painted table
Kelly Jean (Unsplash), via Wikimedia Commons · CC0 1.0 Universal public domain dedication, confirmed on the Wikimedia Commons file page · Image source

Levonorgestrel intrauterine systems

After surgery for endometriosis

A 2021 Cochrane review of the levonorgestrel intrauterine device after surgery for symptomatic endometriosis included four randomized trials with 157 women [6]. The certainty of the evidence was very low to low [6]. No study reported overall pain, the review's primary outcome. Two trials reported dysmenorrhea at 12 months with results favoring the device over expectant management, but the authors could not pool them and were uncertain about the effect [6]. One study reported more melasma and bloating after the device; other adverse events did not differ [6]. The authors concluded that the review found no high-quality evidence to support the common practice and called for larger studies [6].

Heavy menstrual bleeding

The Cochrane review of progestogen-releasing intrauterine systems for heavy menstrual bleeding included 25 trials with 2,511 women [9]. Compared with other medical therapies, the systems may have lowered menstrual blood loss (low-certainty evidence), probably gave slightly higher quality-of-life scores on the SF-36 and the Menorrhagia Multi-Attribute Scale (moderate certainty, one study of 571 women), and had similar serious adverse events [9]. Women allocated to other medical therapy were probably more likely to withdraw than those given the intrauterine system [9]. Compared with endometrial ablation, bleeding results were inconsistent, and women with the system were probably more likely to have any adverse event and may have had more treatment failure at one year [9].

The Cochrane overview of treatments for heavy menstrual bleeding, which used network meta-analysis across nine Cochrane reviews, ranked the levonorgestrel intrauterine system first for reducing menstrual blood loss, based on 26 studies with 1,770 participants and low-certainty evidence [11]. Antifibrinolytics ranked next and long-cycle progestogens third [11]. The overview states that conclusions about perception of improvement and satisfaction could not be drawn because the evidence was very low certainty [11]. A separate Cochrane review of cyclical oral progestogens found 15 trials with 1,071 women, none compared with placebo, most unblinded, and rated the evidence low or very low [10].

The ECLIPSE trial randomized 571 women aged 25 to 50 with heavy menstrual bleeding in English primary care to the intrauterine system or usual medical treatment, and was open-label [29]. At five years, 74% provided data [29]. Scores on the Menorrhagia Multi-Attribute Scale rose by about 44 points in both groups, and the 3.9-point difference between groups was not statistically significant [29]. A 10-year follow-up of 206 responders found that 29.1% had had surgery, 43.2% had stopped all medical treatment between years 5 and 10, and 27.2% were using the intrauterine system at 10 years [30]. Only 206 of the original 571 women responded, and the follow-up was observational [30].

Adenomyosis

A randomized trial of 62 participants with adenomyosis-related pain and bleeding compared a levonorgestrel intrauterine system with a low-dose combined oral contraceptive for 6 months [26]. Both reduced pain and bleeding days, and the reduction was larger with the intrauterine system [26]. A 2025 systematic review of 28 studies concluded that there was no clear evidence to recommend a single-drug therapy for pain and quality of life in adenomyosis within 12 months, though it found added benefit when the intrauterine system was combined with GnRH agonists or with surgery [33].

GnRH-based therapies

GnRH agonists

The 2023 Cochrane review of GnRH analogues for endometriosis included 72 studies with 7,355 patients, with very low to low-quality evidence because of poor reporting of methods and serious imprecision [7]. Compared with placebo, the agonists may have decreased pain scores, based on one trial (low certainty), and may have increased hot flushes [7]. The review also assessed bone mineral density and found a larger decrease with an agonist alone than with an agonist plus calcium-regulating agents in one small trial [7]. It noted a wide range of outcome measures and instruments, and recommended cautious interpretation [7].

Oral GnRH antagonists

The two Elaris trials randomized 872 and 817 women with surgically diagnosed endometriosis and moderate or severe pain to elagolix at a lower or higher dose, or placebo, for 6 months [13]. At 3 months, dysmenorrhea responder rates were 46.4% and 75.8% in the two elagolix groups versus 19.6% with placebo in the first trial, with similar numbers in the second [13]. Nonmenstrual pelvic pain responder rates were 50.4% and 54.5% versus 36.5% [13]. Completion rates at 6 months were 74.9% and 77.4% [13]. The elagolix groups had more hot flushes, higher serum lipids and larger bone density decreases than placebo, and the manufacturer funded the trials [13].

In a trial of elagolix with estradiol and norethindrone acetate add-back versus placebo, 679 patients were randomized [14]. At 6 months, 62.8% of the elagolix with add-back group had improved dysmenorrhea versus 23.7% with placebo, and 51.3% had improved nonmenstrual pelvic pain versus 36.8% [14]. Adverse events occurred in 73.8% with elagolix plus add-back and 66.8% with placebo, and discontinuations related to adverse events were 12.6% and 9.8% [14]. Lumbar spine bone density fell 2.43% in patients given elagolix alone for 6 months, versus under 1% with add-back from the start [14].

The SPIRIT open-label extension followed 802 patients for up to 104 weeks [15]. Among 277 who had been randomized to combination therapy at the start of the pivotal trials, 84.8% and 75.8% were responders for dysmenorrhea and nonmenstrual pelvic pain at week 104 [15]. The authors list limitations: there was no control group during the extension, no comparison with other hormonal drugs, and 37.4% of participants left the study early [15]. A companion analysis reported EHP-30 pain domain scores that improved by 57.8% at week 24 and 72.2% at week 104, with the same open-label limits [16].

The EDELWEISS 3 trial randomized 486 participants to placebo, linzagolix alone, or linzagolix with add-back for up to 6 months [17]. At 3 months, the add-back group met the primary dysmenorrhea and nonmenstrual pelvic pain goals, while linzagolix alone met the dysmenorrhea goal only [17]. Bone density loss was under 1% in both groups [17]. An extension in 353 participants ran from month 6 to month 12 and was followed by 6 months without study drug [18]. Only people who completed the first 6 months entered it [18].

A 2026 meta-analysis of five phase 3 trials of oral GnRH antagonists (2,060 participants, treatment up to 24 weeks) found pooled risk ratios for dysmenorrhea responders of 3.06 and for nonmenstrual pelvic pain responders of 1.53, and indirect comparisons did not show robust differences between the three drugs [32]. A 2025 network meta-analysis of 8 trials with 3,259 patients ranked a higher-dose GnRH antagonist strongest for dysmenorrhea and nonmenstrual pelvic pain, and dienogest as having the fewest adverse effects [31]. Both analyses rely on indirect comparisons across trials [31][32].

What guidelines say

The European Society of Human Reproduction and Embryology (ESHRE) guideline on endometriosis rated as a strong recommendation, based on moderate-certainty evidence, that clinicians offer hormone treatment (combined hormonal contraceptives, progestogens, GnRH agonists or GnRH antagonists) as one of the options to reduce endometriosis-associated pain [1]. It describes a shared decision-making approach that weighs preferences, side effects, efficacy, cost and availability [1]. It places GnRH agonists and antagonists as second-line options because of their side effect profile, and recommends considering add-back therapy with agonists [1]. For adolescents, it describes hormonal contraceptives or progestogens as first-line hormone therapy, with a note that some progestogens may decrease bone mineral density [1]. The guideline itself notes that, based on existing evidence, no firm recommendations could be formulated on the most appropriate treatments [1].

The American College of Obstetricians and Gynecologists (ACOG) Committee Opinion on adolescents states that if dysmenorrhea does not improve within 3 to 6 months of therapy, clinicians should look for secondary causes and for treatment adherence [2].

After surgery: suppression to reduce recurrence

A 2021 meta-analysis of 13 randomized trials and 4 cohort studies (2,137 patients) found that postoperative hormonal suppression was associated with a lower risk of recurrence compared with expectant management or placebo (relative risk 0.41), with substantial heterogeneity (I2 of 68%), and with lower pain scores [25]. Recurrence was defined by imaging or symptoms at least 12 months after surgery, and follow-up ranged from 12 to 36 months [25]. Nine of the 17 studies evaluated GnRH agonists [25].

The PRE-EMPT trial randomized 405 women having conservative surgery at 34 UK hospitals to a long-acting progestogen (depot injection or levonorgestrel intrauterine system) or the combined oral contraceptive pill [24]. It was open-label. At three years, pain on the EHP-30 had improved by about 40% in both groups, with no difference between them [24]. Fewer further surgical procedures or second-line treatments were recorded in the long-acting progestogen group (73 versus 97; hazard ratio 0.67, 95% confidence interval 0.44 to 1.00) [24]. The interval reaches 1.00, so that secondary result is uncertain.

How long the trials last

Placebo-controlled periods in most of the drug trials described here lasted 24 weeks to 6 months [13][17][21][23], and one elagolix add-back trial had a 12-month double-blind period [14]. The adenomyosis trials ran 12 weeks, 16 weeks and 6 months [26][27][28]. Longer data come from open-label extensions, from pragmatic trials of 3 and 5 years (PRE-EMPT and ECLIPSE), and from observational follow-up [15][18][22][24][29][30]. In the extensions described here, all participants received active drug, and only people who completed the first phase and chose to continue were followed [15][18][22].

How side effects are reported

Side effects are reported in at least four ways, and a reader comparing trials needs to know which one is used.

First, trials report the share of participants with any adverse event, as in the elagolix add-back trial (73.8% versus 66.8%) [14]. Second, they name specific events, such as irregular bleeding, headache, nausea, hot flushes or melasma [6][8][19]. Third, they measure laboratory or imaging outcomes, such as bone density or serum lipids, which participants may not notice [13][14]. Fourth, they report withdrawals caused by adverse events [5][14].

Irregular bleeding was reported more often than with placebo in the Cochrane pill review [8], and hot flushes more often in the Cochrane GnRH review [7]. In dienogest and levonorgestrel intrauterine system trials irregular bleeding was frequent, and almost all treated patients in a 16-week adenomyosis trial reported it [6][19][28]. Moussaoui and colleagues, in a systematic review of 20 studies with 3,317 adolescents and young adults who have developmental disability, found that breakthrough bleeding was the most common side effect and the primary reason for stopping or switching hormonal medication, and that 45.4% of levonorgestrel intrauterine device users experienced amenorrhea [35].

The Cochrane review of cyclical progestogens assessed adverse events only where trials measured them separately [10], and the extended-cycle contraception review could not pool data [12].

Larger population studies of contraceptive safety

Some outcomes have been examined in registry cohorts of people who used contraception for any reason. Those cohorts do not describe people using hormones for pain or bleeding. A Danish registry cohort of 1.8 million women followed for a mean of 10.9 years found a higher relative risk of breast cancer among current and recent users of hormonal contraception (relative risk 1.20), rising with duration of use; the authors estimated roughly one extra breast cancer for every 7,690 women using hormonal contraception for one year [40]. A Danish registry cohort of about 1.06 million women aged 15 to 34 found higher rates of starting antidepressants among users of several hormonal methods, with a relative risk of 1.23 for combined pills and 1.4 for the levonorgestrel intrauterine system [41]. A Danish study of 1.6 million women found a relative risk of venous thrombosis of 7.9 for patches and 6.5 for vaginal rings versus non-users, while the levonorgestrel intrauterine system showed a relative risk of 0.6 [42]. Because these studies are observational, they show associations only.

Stopping, switching and discontinuation

Trials count discontinuation in different ways. Some count people who stopped study treatment, some count people who left the trial, and some count only those whose reason was an adverse event [5][14]. In the Elaris EM-I and EM-II trials, 74.9% and 77.4% completed 6 months of treatment [13]. In the SPIRIT extension, 62.5% completed 104 weeks [15]. The Cochrane review of intrauterine systems for heavy bleeding found people were more likely to withdraw from other medical therapy than from the system [9]. In the open-label dienogest extension, 92.3% of the 220 people who entered finished it and 0.9% withdrew for adverse events [22], but these were participants who had already completed a 24-week trial.

In the ECLIPSE 10-year follow-up, 43.2% of 206 respondents ceased all medical treatment between years 5 and 10 [30]. The abstract does not report reasons, so it does not say whether treatment was stopped because bleeding improved, because of menopause, or for another reason.

Few trials follow people after treatment ends. The EDELWEISS extension included 6 months without study drug [18].

Why trial results are hard to compare

Several features limit what can be concluded from these trials.

Different diagnoses. Some trials enrolled only surgically confirmed endometriosis [4][5][13][21]. Others included imaging diagnoses [20][32]. The dysmenorrhea review specifically excluded pelvic pathology [8]. Results from one group do not necessarily apply to another.

Industry funding. The elagolix and linzagolix trials were funded by the companies that make the drugs [13][17]. The Cochrane review of oral contraceptives noted substantial involvement of the funder [4]. Funding by a manufacturer does not by itself show that results are wrong. It is one factor reviewers record when judging risk of bias.

Open-label designs and subjective outcomes. Pain, bleeding and satisfaction are self-reported. In unblinded trials, participants know which treatment they get. In the cyclical progestogen review, most women knew which treatment they were receiving, which may have influenced judgments about blood loss and satisfaction [10]. PRE-EMPT and ECLIPSE were also open-label [24][29].

Placebo and comparator choices. Many of the newer drug trials compare with placebo, so they do not tell us how they compare with a combined pill or progestin. The linzagolix authors state this directly [17].

Small numbers. The Cochrane review of the levonorgestrel intrauterine device after endometriosis surgery had 157 women in four trials [6].

Inconsistent outcomes. A systematic review of 54 randomized trials of endometriosis surgery, with or without medical adjuvant therapy, found 164 outcomes and 113 outcome measures, which the authors said prevented comparison, combination and synthesis of data [38]. For adenomyosis, an international consensus process involving 150 health professionals, 17 researchers and 334 people with lived experience produced a core outcome set of 24 specific and 26 generic outcomes in nine domains, including pain, uterine bleeding and adverse events [39]. These efforts aim to make future trials comparable.

Who is enrolled. A consensus study on adenomyosis outcomes reported that patients from continents other than Europe were under-represented [39]. The review on developmental disability combined 20 studies with 14 to 1,560 participants each [35].

What this does not tell you

This article describes research. It cannot tell a reader which method suits a particular person, what dose or schedule a clinician might choose, or how a person's own pain or bleeding will respond. Averages from trials describe groups, and individual responses vary within them.

The studies do not settle whether one hormone type outperforms another for pain, because direct comparisons are few and mostly low-certainty [5][7]. They say little about blinded outcomes beyond about two years, about what happens after stopping, or about people whose pain has several causes. A reduction in a pain score is not the same as a diagnosis, and a lower bleeding score does not show what caused the bleeding.

Reported symptoms, clinical examination, imaging, surgical findings and pathology are different kinds of evidence, and the trials above used different combinations of them to define who took part [4][13][20]. The population-level safety studies describe associations among people using contraception, and cannot show what any one person's risk would be.

Decisions about any of these treatments involve a person's health history, preferences, plans for pregnancy and other conditions, which belong in conversation with a clinician who knows the person.

References

  1. Becker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L, et al. ESHRE guideline: endometriosis. Hum Reprod Open. 2022;2022(2):hoac009. doi:10.1093/hropen/hoac009. PMID 35350465. https://pubmed.ncbi.nlm.nih.gov/35350465/
  2. American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 760: Dysmenorrhea and Endometriosis in the Adolescent. Obstet Gynecol. 2018;132(6):e249-e258. doi:10.1097/AOG.0000000000002978. PMID 30461694. https://pubmed.ncbi.nlm.nih.gov/30461694/
  3. Dason ES, Maxim M, Sanders A, Papillon-Smith J, Ng D, Chan C, et al. Guideline No. 437: Diagnosis and Management of Adenomyosis. J Obstet Gynaecol Can. 2023;45(6):417-429.e1. doi:10.1016/j.jogc.2023.04.008. PMID 37244746. https://pubmed.ncbi.nlm.nih.gov/37244746/
  4. Brown J, Crawford TJ, Datta S, Prentice A. Oral contraceptives for pain associated with endometriosis. Cochrane Database Syst Rev. 2018;5(5):CD001019. doi:10.1002/14651858.CD001019.pub3. PMID 29786828. https://pubmed.ncbi.nlm.nih.gov/29786828/
  5. Chen I, Kives S, Zakhari A, Nguyen DB, Goldberg HR, Choudhry AJ, et al. Progestagens for pain symptoms associated with endometriosis. Cochrane Database Syst Rev. 2025;10(10):CD002122. doi:10.1002/14651858.CD002122.pub3. PMID 41065045. https://pubmed.ncbi.nlm.nih.gov/41065045/
  6. Gibbons T, Georgiou EX, Cheong YC, Wise MR. Levonorgestrel-releasing intrauterine device (LNG-IUD) for symptomatic endometriosis following surgery. Cochrane Database Syst Rev. 2021;12(12):CD005072. doi:10.1002/14651858.CD005072.pub4. PMID 34928503. https://pubmed.ncbi.nlm.nih.gov/34928503/
  7. Veth VB, van de Kar MM, Duffy JM, van Wely M, Mijatovic V, Maas JW. Gonadotropin-releasing hormone analogues for endometriosis. Cochrane Database Syst Rev. 2023;6(6):CD014788. doi:10.1002/14651858.CD014788.pub2. PMID 37341141. https://pubmed.ncbi.nlm.nih.gov/37341141/
  8. Schroll JB, Black AY, Farquhar C, Chen I. Combined oral contraceptive pill for primary dysmenorrhoea. Cochrane Database Syst Rev. 2023;7(7):CD002120. doi:10.1002/14651858.CD002120.pub4. PMID 37523477. https://pubmed.ncbi.nlm.nih.gov/37523477/
  9. Bofill Rodriguez M, Lethaby A, Jordan V. Progestogen-releasing intrauterine systems for heavy menstrual bleeding. Cochrane Database Syst Rev. 2020;6(6):CD002126. doi:10.1002/14651858.CD002126.pub4. PMID 32529637. https://pubmed.ncbi.nlm.nih.gov/32529637/
  10. Bofill Rodriguez M, Lethaby A, Low C, Cameron IT. Cyclical progestogens for heavy menstrual bleeding. Cochrane Database Syst Rev. 2019;8(8):CD001016. doi:10.1002/14651858.CD001016.pub3. PMID 31425626. https://pubmed.ncbi.nlm.nih.gov/31425626/
  11. Bofill Rodriguez M, Dias S, Jordan V, Lethaby A, Lensen SF, Wise MR, et al. Interventions for heavy menstrual bleeding; overview of Cochrane reviews and network meta-analysis. Cochrane Database Syst Rev. 2022;5(5):CD013180. doi:10.1002/14651858.CD013180.pub2. PMID 35638592. https://pubmed.ncbi.nlm.nih.gov/35638592/
  12. Edelman A, Micks E, Gallo MF, Jensen JT, Grimes DA. Continuous or extended cycle vs. cyclic use of combined hormonal contraceptives for contraception. Cochrane Database Syst Rev. 2014;2014(7):CD004695. doi:10.1002/14651858.CD004695.pub3. PMID 25072731. https://pubmed.ncbi.nlm.nih.gov/25072731/
  13. Taylor HS, Giudice LC, Lessey BA, Abrao MS, Kotarski J, Archer DF, et al. Treatment of Endometriosis-Associated Pain with Elagolix, an Oral GnRH Antagonist. N Engl J Med. 2017;377(1):28-40. doi:10.1056/NEJMoa1700089. PMID 28525302. https://pubmed.ncbi.nlm.nih.gov/28525302/
  14. Miller CE, Kim JH, Kroll R, Simon JA, Soliman AM, Thomas JW, et al. Efficacy, tolerability, and bone density outcomes of elagolix with add-back therapy for endometriosis-associated pain: twelve months of an ongoing randomized phase 3 trial. Am J Obstet Gynecol. 2024;231(6):630.e1-630.e13. doi:10.1016/j.ajog.2024.06.040. PMID 38955323. https://pubmed.ncbi.nlm.nih.gov/38955323/
  15. Becker CM, Johnson NP, As-Sanie S, Arjona Ferreira JC, Abrao MS, Wilk K, et al. Two-year efficacy and safety of relugolix combination therapy in women with endometriosis-associated pain: SPIRIT open-label extension study. Hum Reprod. 2024;39(3):526-537. doi:10.1093/humrep/dead263. PMID 38243752. https://pubmed.ncbi.nlm.nih.gov/38243752/
  16. As-Sanie S, Abrao MS, Reznichenko G, Wilk K, Zhong Y, Perry J, et al. Impact of relugolix combination therapy on functioning and quality of life in women with endometriosis-associated pain. Fertil Steril. 2024;122(4):687-695. doi:10.1016/j.fertnstert.2024.06.009. PMID 38906210. https://pubmed.ncbi.nlm.nih.gov/38906210/
  17. Donnez J, Becker C, Taylor H, Carmona Herrera F, Donnez O, Horne A, et al. Linzagolix therapy versus a placebo in patients with endometriosis-associated pain: a prospective, randomized, double-blind, Phase 3 study (EDELWEISS 3). Hum Reprod. 2024;39(6):1208-1221. doi:10.1093/humrep/deae076. PMID 38648863. https://pubmed.ncbi.nlm.nih.gov/38648863/
  18. Donnez J, Becker CM, Petraglia F, Horne AW, Becker S, Renner SP, et al. Linzagolix, with and without add-back therapy, in women with endometriosis-associated pain: results from EDELWEISS 6, a double-blind randomized extension and withdrawal study. Hum Reprod Open. 2026;2026(2):hoag030. doi:10.1093/hropen/hoag030. PMID 42077502. https://pubmed.ncbi.nlm.nih.gov/42077502/
  19. Harada T, Momoeda M, Taketani Y, Aso T, Fukunaga M, Hagino H, et al. Dienogest is as effective as intranasal buserelin acetate for the relief of pain symptoms associated with endometriosis--a randomized, double-blind, multicenter, controlled trial. Fertil Steril. 2009;91(3):675-81. doi:10.1016/j.fertnstert.2007.12.080. PMID 18653184. https://pubmed.ncbi.nlm.nih.gov/18653184/
  20. Harada T, Momoeda M, Taketani Y, Hoshiai H, Terakawa N. Low-dose oral contraceptive pill for dysmenorrhea associated with endometriosis: a placebo-controlled, double-blind, randomized trial. Fertil Steril. 2008;90(5):1583-8. doi:10.1016/j.fertnstert.2007.08.051. PMID 18164001. https://pubmed.ncbi.nlm.nih.gov/18164001/
  21. Lang J, Yu Q, Zhang S, Li H, Gude K, von Ludwig C, et al. Dienogest for Treatment of Endometriosis in Chinese Women: A Placebo-Controlled, Randomized, Double-Blind Phase 3 Study. J Womens Health (Larchmt). 2018;27(2):148-155. doi:10.1089/jwh.2017.6399. PMID 29083258. https://pubmed.ncbi.nlm.nih.gov/29083258/
  22. Yu Q, Zhang S, Li H, Wang P, Zvolanek M, Ren X, et al. Dienogest for Treatment of Endometriosis in Women: A 28-Week, Open-Label, Extension Study. J Womens Health (Larchmt). 2019;28(2):170-177. doi:10.1089/jwh.2018.7084. PMID 30461337. https://pubmed.ncbi.nlm.nih.gov/30461337/
  23. Harada T, Kosaka S, Elliesen J, Yasuda M, Ito M, Momoeda M. Ethinylestradiol 20 μg/drospirenone 3 mg in a flexible extended regimen for the management of endometriosis-associated pelvic pain: a randomized controlled trial. Fertil Steril. 2017;108(5):798-805. doi:10.1016/j.fertnstert.2017.07.1165. PMID 28911925. https://pubmed.ncbi.nlm.nih.gov/28911925/
  24. Cooper KG, Bhattacharya S, Daniels JP, Horne AW, Clark TJ, Saridogan E, et al. Long acting progestogens versus combined oral contraceptive pill for preventing recurrence of endometriosis related pain: the PRE-EMPT pragmatic, parallel group, open label, randomised controlled trial. BMJ. 2024;385:e079006. doi:10.1136/bmj-2023-079006. PMID 38749550. https://pubmed.ncbi.nlm.nih.gov/38749550/
  25. Zakhari A, Delpero E, McKeown S, Tomlinson G, Bougie O, Murji A. Endometriosis recurrence following post-operative hormonal suppression: a systematic review and meta-analysis. Hum Reprod Update. 2021;27(1):96-107. doi:10.1093/humupd/dmaa033. PMID 33020832. https://pubmed.ncbi.nlm.nih.gov/33020832/
  26. Shaaban OM, Ali MK, Sabra AM, Abd El Aal DE. Levonorgestrel-releasing intrauterine system versus a low-dose combined oral contraceptive for treatment of adenomyotic uteri: a randomized clinical trial. Contraception. 2015;92(4):301-7. doi:10.1016/j.contraception.2015.05.015. PMID 26071673. https://pubmed.ncbi.nlm.nih.gov/26071673/
  27. Choudhury S, Jena SK, Mitra S, Padhy BM, Mohakud S. Comparison of efficacy between levonorgestrel intrauterine system and dienogest in adenomyosis: a randomized clinical trial. Ther Adv Reprod Health. 2024;18:26334941241227401. doi:10.1177/26334941241227401. PMID 38283750. https://pubmed.ncbi.nlm.nih.gov/38283750/
  28. Osuga Y, Fujimoto-Okabe H, Hagino A. Evaluation of the efficacy and safety of dienogest in the treatment of painful symptoms in patients with adenomyosis: a randomized, double-blind, multicenter, placebo-controlled study. Fertil Steril. 2017;108(4):673-678. doi:10.1016/j.fertnstert.2017.07.021. PMID 28911934. https://pubmed.ncbi.nlm.nih.gov/28911934/
  29. Kai J, Middleton L, Daniels J, Pattison H, Tryposkiadis K, Gupta J, et al. Usual medical treatments or levonorgestrel-IUS for women with heavy menstrual bleeding: long-term randomised pragmatic trial in primary care. Br J Gen Pract. 2016;66(653):e861-e870. doi:10.3399/bjgp16X687577. PMID 27884916. https://pubmed.ncbi.nlm.nih.gov/27884916/
  30. Kai J, Dutton B, Vinogradova Y, Hilken N, Gupta J, Daniels J. Medical treatment for heavy menstrual bleeding in primary care: 10-year data from the ECLIPSE trial. Br J Gen Pract. 2022;72(725):e857-e864. doi:10.3399/bjgp.2022.0260. PMID 36376071. https://pubmed.ncbi.nlm.nih.gov/36376071/
  31. Dick A, Matok I, Gutman-Ido E, Lessans N, Dior UP. GnRH analogues and dienogest for second line treatment of endometriosis-associated pain: a systematic review, meta-analysis, and network meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2025;312:114093. doi:10.1016/j.ejogrb.2025.114093. PMID 40517509. https://pubmed.ncbi.nlm.nih.gov/40517509/
  32. Hsu R, Han ES, Farrow M, Pacis M, Swartz S, Denny K. Oral Gonadotropin-Releasing Hormone Antagonists for the Treatment of Endometriosis-Associated Pain: A Systematic Review and Meta-Analysis. J Minim Invasive Gynecol. 2026;33(10):1526-1532.e3. doi:10.1016/j.jmig.2026.04.004. PMID 42025872. https://pubmed.ncbi.nlm.nih.gov/42025872/
  33. Zhang B, Shi J, Gu Z, Wu Y, Li X, Zhang C, et al. The role of different LNG-IUS therapies in the management of adenomyosis: a systematic review and meta-analysis. Reprod Biol Endocrinol. 2025;23(1):23. doi:10.1186/s12958-025-01349-4. PMID 39948612. https://pubmed.ncbi.nlm.nih.gov/39948612/
  34. Jiang L, Kshatriya M, Bhutta ZA, Santesso N, Kamuyango A, Kidula N, et al. Effectiveness, safety and acceptability of continuous or extended-cycle use of combined oral contraceptives (COCs): a systematic review and meta-analysis. BMJ Sex Reprod Health. 2026;52(Suppl 2):s33-s48. doi:10.1136/bmjsrh-2026-203331. PMID 42778302. https://pubmed.ncbi.nlm.nih.gov/42778302/
  35. Moussaoui D, Laqua J, Crofts VL, Nemitz-Piguet CM, Héritier-Barras AC, Merglen A, et al. Menstrual management using hormonal medications in adolescents and young adults with developmental disability: a systematic review and a meta-analysis. J Obstet Gynaecol. 2025;45(1):2521804. doi:10.1080/01443615.2025.2521804. PMID 40576248. https://pubmed.ncbi.nlm.nih.gov/40576248/
  36. Vercellini P, Buggio L, Berlanda N, Barbara G, Somigliana E, Bosari S. Estrogen-progestins and progestins for the management of endometriosis. Fertil Steril. 2016;106(7):1552-1571.e2. doi:10.1016/j.fertnstert.2016.10.022. PMID 27817837. https://pubmed.ncbi.nlm.nih.gov/27817837/
  37. Bourdel N, Alves J, Pickering G, Ramilo I, Roman H, Canis M. Systematic review of endometriosis pain assessment: how to choose a scale?. Hum Reprod Update. 2015;21(1):136-52. doi:10.1093/humupd/dmu046. PMID 25180023. https://pubmed.ncbi.nlm.nih.gov/25180023/
  38. Hirsch M, Duffy JMN, Kusznir JO, Davis CJ, Plana MN, Khan KS, et al. Variation in outcome reporting in endometriosis trials: a systematic review. Am J Obstet Gynecol. 2016;214(4):452-464. doi:10.1016/j.ajog.2015.12.039. PMID 26778385. https://pubmed.ncbi.nlm.nih.gov/26778385/
  39. Tellum T, Naftalin J, Chapron C, Dueholm M, Guo SW, Hirsch M, et al. Development of a core outcome set and outcome definitions for studies on uterus-sparing treatments of adenomyosis (COSAR): an international multistakeholder-modified Delphi consensus study. Hum Reprod. 2022;37(9):2012-2031. doi:10.1093/humrep/deac166. PMID 35906919. https://pubmed.ncbi.nlm.nih.gov/35906919/
  40. Mørch LS, Skovlund CW, Hannaford PC, Iversen L, Fielding S, Lidegaard Ø. Contemporary Hormonal Contraception and the Risk of Breast Cancer. N Engl J Med. 2017;377(23):2228-2239. doi:10.1056/NEJMoa1700732. PMID 29211679. https://pubmed.ncbi.nlm.nih.gov/29211679/
  41. Skovlund CW, Mørch LS, Kessing LV, Lidegaard Ø. Association of Hormonal Contraception With Depression. JAMA Psychiatry. 2016;73(11):1154-1162. doi:10.1001/jamapsychiatry.2016.2387. PMID 27680324. https://pubmed.ncbi.nlm.nih.gov/27680324/
  42. Lidegaard O, Nielsen LH, Skovlund CW, Løkkegaard E. Venous thrombosis in users of non-oral hormonal contraception: follow-up study, Denmark 2001-10. BMJ. 2012;344:e2990. doi:10.1136/bmj.e2990. PMID 22577198. https://pubmed.ncbi.nlm.nih.gov/22577198/

References

  1. Becker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L, et al. ESHRE guideline: endometriosis. Hum Reprod Open. 2022;2022(2):hoac009. DOI · PMID 35350465
  2. American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 760: Dysmenorrhea and Endometriosis in the Adolescent. Obstet Gynecol. 2018;132(6):e249-e258. DOI · PMID 30461694
  3. Dason ES, Maxim M, Sanders A, Papillon-Smith J, Ng D, Chan C, et al. Guideline No. 437: Diagnosis and Management of Adenomyosis. J Obstet Gynaecol Can. 2023;45(6):417-429.e1. DOI · PMID 37244746
  4. Brown J, Crawford TJ, Datta S, Prentice A. Oral contraceptives for pain associated with endometriosis. Cochrane Database Syst Rev. 2018;5(5):CD001019. DOI · PMID 29786828
  5. Chen I, Kives S, Zakhari A, Nguyen DB, Goldberg HR, Choudhry AJ, et al. Progestagens for pain symptoms associated with endometriosis. Cochrane Database Syst Rev. 2025;10(10):CD002122. DOI · PMID 41065045
  6. Gibbons T, Georgiou EX, Cheong YC, Wise MR. Levonorgestrel-releasing intrauterine device (LNG-IUD) for symptomatic endometriosis following surgery. Cochrane Database Syst Rev. 2021;12(12):CD005072. DOI · PMID 34928503
  7. Veth VB, van de Kar MM, Duffy JM, van Wely M, Mijatovic V, Maas JW. Gonadotropin-releasing hormone analogues for endometriosis. Cochrane Database Syst Rev. 2023;6(6):CD014788. DOI · PMID 37341141
  8. Schroll JB, Black AY, Farquhar C, Chen I. Combined oral contraceptive pill for primary dysmenorrhoea. Cochrane Database Syst Rev. 2023;7(7):CD002120. DOI · PMID 37523477
  9. Bofill Rodriguez M, Lethaby A, Jordan V. Progestogen-releasing intrauterine systems for heavy menstrual bleeding. Cochrane Database Syst Rev. 2020;6(6):CD002126. DOI · PMID 32529637
  10. Bofill Rodriguez M, Lethaby A, Low C, Cameron IT. Cyclical progestogens for heavy menstrual bleeding. Cochrane Database Syst Rev. 2019;8(8):CD001016. DOI · PMID 31425626
  11. Bofill Rodriguez M, Dias S, Jordan V, Lethaby A, Lensen SF, Wise MR, et al. Interventions for heavy menstrual bleeding; overview of Cochrane reviews and network meta-analysis. Cochrane Database Syst Rev. 2022;5(5):CD013180. DOI · PMID 35638592
  12. Edelman A, Micks E, Gallo MF, Jensen JT, Grimes DA. Continuous or extended cycle vs. cyclic use of combined hormonal contraceptives for contraception. Cochrane Database Syst Rev. 2014;2014(7):CD004695. DOI · PMID 25072731
  13. Taylor HS, Giudice LC, Lessey BA, Abrao MS, Kotarski J, Archer DF, et al. Treatment of Endometriosis-Associated Pain with Elagolix, an Oral GnRH Antagonist. N Engl J Med. 2017;377(1):28-40. DOI · PMID 28525302
  14. Miller CE, Kim JH, Kroll R, Simon JA, Soliman AM, Thomas JW, et al. Efficacy, tolerability, and bone density outcomes of elagolix with add-back therapy for endometriosis-associated pain: twelve months of an ongoing randomized phase 3 trial. Am J Obstet Gynecol. 2024;231(6):630.e1-630.e13. DOI · PMID 38955323
  15. Becker CM, Johnson NP, As-Sanie S, Arjona Ferreira JC, Abrao MS, Wilk K, et al. Two-year efficacy and safety of relugolix combination therapy in women with endometriosis-associated pain: SPIRIT open-label extension study. Hum Reprod. 2024;39(3):526-537. DOI · PMID 38243752
  16. As-Sanie S, Abrao MS, Reznichenko G, Wilk K, Zhong Y, Perry J, et al. Impact of relugolix combination therapy on functioning and quality of life in women with endometriosis-associated pain. Fertil Steril. 2024;122(4):687-695. DOI · PMID 38906210
  17. Donnez J, Becker C, Taylor H, Carmona Herrera F, Donnez O, Horne A, et al. Linzagolix therapy versus a placebo in patients with endometriosis-associated pain: a prospective, randomized, double-blind, Phase 3 study (EDELWEISS 3). Hum Reprod. 2024;39(6):1208-1221. DOI · PMID 38648863
  18. Donnez J, Becker CM, Petraglia F, Horne AW, Becker S, Renner SP, et al. Linzagolix, with and without add-back therapy, in women with endometriosis-associated pain: results from EDELWEISS 6, a double-blind randomized extension and withdrawal study. Hum Reprod Open. 2026;2026(2):hoag030. DOI · PMID 42077502
  19. Harada T, Momoeda M, Taketani Y, Aso T, Fukunaga M, Hagino H, et al. Dienogest is as effective as intranasal buserelin acetate for the relief of pain symptoms associated with endometriosis--a randomized, double-blind, multicenter, controlled trial. Fertil Steril. 2009;91(3):675-81. DOI · PMID 18653184
  20. Harada T, Momoeda M, Taketani Y, Hoshiai H, Terakawa N. Low-dose oral contraceptive pill for dysmenorrhea associated with endometriosis: a placebo-controlled, double-blind, randomized trial. Fertil Steril. 2008;90(5):1583-8. DOI · PMID 18164001
  21. Lang J, Yu Q, Zhang S, Li H, Gude K, von Ludwig C, et al. Dienogest for Treatment of Endometriosis in Chinese Women: A Placebo-Controlled, Randomized, Double-Blind Phase 3 Study. J Womens Health (Larchmt). 2018;27(2):148-155. DOI · PMID 29083258
  22. Yu Q, Zhang S, Li H, Wang P, Zvolanek M, Ren X, et al. Dienogest for Treatment of Endometriosis in Women: A 28-Week, Open-Label, Extension Study. J Womens Health (Larchmt). 2019;28(2):170-177. DOI · PMID 30461337
  23. Harada T, Kosaka S, Elliesen J, Yasuda M, Ito M, Momoeda M. Ethinylestradiol 20 μg/drospirenone 3 mg in a flexible extended regimen for the management of endometriosis-associated pelvic pain: a randomized controlled trial. Fertil Steril. 2017;108(5):798-805. DOI · PMID 28911925
  24. Cooper KG, Bhattacharya S, Daniels JP, Horne AW, Clark TJ, Saridogan E, et al. Long acting progestogens versus combined oral contraceptive pill for preventing recurrence of endometriosis related pain: the PRE-EMPT pragmatic, parallel group, open label, randomised controlled trial. BMJ. 2024;385:e079006. DOI · PMID 38749550
  25. Zakhari A, Delpero E, McKeown S, Tomlinson G, Bougie O, Murji A. Endometriosis recurrence following post-operative hormonal suppression: a systematic review and meta-analysis. Hum Reprod Update. 2021;27(1):96-107. DOI · PMID 33020832
  26. Shaaban OM, Ali MK, Sabra AM, Abd El Aal DE. Levonorgestrel-releasing intrauterine system versus a low-dose combined oral contraceptive for treatment of adenomyotic uteri: a randomized clinical trial. Contraception. 2015;92(4):301-7. DOI · PMID 26071673
  27. Choudhury S, Jena SK, Mitra S, Padhy BM, Mohakud S. Comparison of efficacy between levonorgestrel intrauterine system and dienogest in adenomyosis: a randomized clinical trial. Ther Adv Reprod Health. 2024;18:26334941241227401. DOI · PMID 38283750
  28. Osuga Y, Fujimoto-Okabe H, Hagino A. Evaluation of the efficacy and safety of dienogest in the treatment of painful symptoms in patients with adenomyosis: a randomized, double-blind, multicenter, placebo-controlled study. Fertil Steril. 2017;108(4):673-678. DOI · PMID 28911934
  29. Kai J, Middleton L, Daniels J, Pattison H, Tryposkiadis K, Gupta J, et al. Usual medical treatments or levonorgestrel-IUS for women with heavy menstrual bleeding: long-term randomised pragmatic trial in primary care. Br J Gen Pract. 2016;66(653):e861-e870. DOI · PMID 27884916
  30. Kai J, Dutton B, Vinogradova Y, Hilken N, Gupta J, Daniels J. Medical treatment for heavy menstrual bleeding in primary care: 10-year data from the ECLIPSE trial. Br J Gen Pract. 2022;72(725):e857-e864. DOI · PMID 36376071
  31. Dick A, Matok I, Gutman-Ido E, Lessans N, Dior UP. GnRH analogues and dienogest for second line treatment of endometriosis-associated pain: a systematic review, meta-analysis, and network meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2025;312:114093. DOI · PMID 40517509
  32. Hsu R, Han ES, Farrow M, Pacis M, Swartz S, Denny K. Oral Gonadotropin-Releasing Hormone Antagonists for the Treatment of Endometriosis-Associated Pain: A Systematic Review and Meta-Analysis. J Minim Invasive Gynecol. 2026;33(10):1526-1532.e3. DOI · PMID 42025872
  33. Zhang B, Shi J, Gu Z, Wu Y, Li X, Zhang C, et al. The role of different LNG-IUS therapies in the management of adenomyosis: a systematic review and meta-analysis. Reprod Biol Endocrinol. 2025;23(1):23. DOI · PMID 39948612
  34. Jiang L, Kshatriya M, Bhutta ZA, Santesso N, Kamuyango A, Kidula N, et al. Effectiveness, safety and acceptability of continuous or extended-cycle use of combined oral contraceptives (COCs): a systematic review and meta-analysis. BMJ Sex Reprod Health. 2026;52(Suppl 2):s33-s48. DOI · PMID 42778302
  35. Moussaoui D, Laqua J, Crofts VL, Nemitz-Piguet CM, Héritier-Barras AC, Merglen A, et al. Menstrual management using hormonal medications in adolescents and young adults with developmental disability: a systematic review and a meta-analysis. J Obstet Gynaecol. 2025;45(1):2521804. DOI · PMID 40576248
  36. Vercellini P, Buggio L, Berlanda N, Barbara G, Somigliana E, Bosari S. Estrogen-progestins and progestins for the management of endometriosis. Fertil Steril. 2016;106(7):1552-1571.e2. DOI · PMID 27817837
  37. Bourdel N, Alves J, Pickering G, Ramilo I, Roman H, Canis M. Systematic review of endometriosis pain assessment: how to choose a scale?. Hum Reprod Update. 2015;21(1):136-52. DOI · PMID 25180023
  38. Hirsch M, Duffy JMN, Kusznir JO, Davis CJ, Plana MN, Khan KS, et al. Variation in outcome reporting in endometriosis trials: a systematic review. Am J Obstet Gynecol. 2016;214(4):452-464. DOI · PMID 26778385
  39. Tellum T, Naftalin J, Chapron C, Dueholm M, Guo SW, Hirsch M, et al. Development of a core outcome set and outcome definitions for studies on uterus-sparing treatments of adenomyosis (COSAR): an international multistakeholder-modified Delphi consensus study. Hum Reprod. 2022;37(9):2012-2031. DOI · PMID 35906919
  40. Mørch LS, Skovlund CW, Hannaford PC, Iversen L, Fielding S, Lidegaard Ø. Contemporary Hormonal Contraception and the Risk of Breast Cancer. N Engl J Med. 2017;377(23):2228-2239. DOI · PMID 29211679
  41. Skovlund CW, Mørch LS, Kessing LV, Lidegaard Ø. Association of Hormonal Contraception With Depression. JAMA Psychiatry. 2016;73(11):1154-1162. DOI · PMID 27680324
  42. Lidegaard O, Nielsen LH, Skovlund CW, Løkkegaard E. Venous thrombosis in users of non-oral hormonal contraception: follow-up study, Denmark 2001-10. BMJ. 2012;344:e2990. DOI · PMID 22577198