Estradiol valerate 2mg / Dienogest 2mg tablets

ObjectiveTo compare the short-term effects of dienogest and oral contraceptives (OCPs) on pain and quality of life in women with endometriosis.MethodThe databases including PubMed, Cochrane Library, Embase, Web of Science, CNKI, and Wanfang Database were searched, and the date ranged from the establishment of the database to November 2024. The randomized controlled trials (RCTs) compared the efficacy of dienogest and oral contraceptives in the treatment of endometriosis were included. The indicators for evaluation mainly included pain score and quality of life. The secondary indicator was safety.ResultsEight studies were included in this meta-analysis. Subgroup analysis was used to assess the endometriosis-related pain because patients received different types of OCPs. Dienogest was superior to mifepristone and Yasmin in improving VAS scores (P = 0.04, SMD=-1.19, 95%CI=-2.32 to -0.06; P = 0.03, SMD=-1.66, 95%CI=-3.16 to -0.15). However, Dienogest was not as effective as OCPs in improving pelvic pain and dyspareunia associated with endometriosis (P = 0.009, SMD = 0.42, 95%CI = 0.11 to 0.73; P = 0.006, SMD = 0.70, 95%CI = 0.20 to 1.19). For QoL score, compared to OCPs, dienogest significantly improved EHP-5, EHP-30, and SF-12 average PCS scores (P  0.05). For side effects after treatment, there is no significant difference in the risk of vaginal bleeding, headache, hot flashes, back pain, skin dryness, and nausea between dienogest and OCPs. But, OCPs increase the risk of hand numbness and weight gain.ConclusionDienogest is superior to OCPs in improving pain and QoL in patients with endometriosis, but not as effective as OCPs in pelvic pain and dyspareunia, and the safety was similar between the two types of drugs.

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ObjectivesDeep endometriosis (DE) is a common disease in 15%-45% of childbearing-age women. Combined oral contraceptive pill (COCP) and dienogest have been used for decades to treat many forms of endometriosis after laparoscopy surgery. This study aims to assess the latest evidence on the effect of dienogest compared with the COCP on the pain scores of dysmenorrhea, dyspareunia, and dyschezia in DE patients.Materials and methodsData from 1363 samples of 9 research literature were taken. The postlaparoscopy surgical patients are divided into the dienogest group and the COCP group. The main symptoms were assessed using a visual analog scale for dysmenorrhea, dyspareunia, and dyschezia in addition to the demographic data from patients of the 2 study groups being compared.ResultsSeven studies show significant differences in dysmenorrhea scores between the dienogest group and the COCP group. Dyspareunia scores in cases of postoperative endometriosis implants showed 6 studies with lower dyspareunia scores in the dienogest group than the COCP group, while 3 other articles showed higher dyspareunia scores in the dienogest group than in the COCP group. Assessment of the risk of bias in the meta-analysis of the therapeutic effectiveness of the Egger regression test shows nonsignificant results which proves no tendency for publication bias (t = 1.111; df = 7.00; P = 0.303).ConclusionDienogest is an effective pain treatment and it is effective for a subgroup of patients with endometriosis and pelvic pain. It is well tolerated as a pain treatment in adenomyosis patients without complications of severe uterine enlargement or severe anemia.

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Endometriosis is a long-term gynecological condition marked by the growth of endometrial-like tissue outside the uterus, which undergoes proliferation, bleeding, and regeneration. This disease is associated with disrupted steroid hormone signaling, notably progesterone (P4) resistance and estradiol (E2) dominance. P4 resistance has been associated with impaired activation of the progesterone receptor (PR) and reduced transcription of P4 target genes, while elevated E2 levels induce estrogen receptor (ER)-mediated signaling, enhancing estrogen-dependent lesion growth. This hormonal imbalance contributes to a pro-inflammatory microenvironment, chronic pelvic pain, infertility, and enhanced neuroangiogenesis. Emerging evidence indicates that the coordinated regulation of neurotrophins and sex hormones promotes nerve fibers and blood vessel growth and invasion within endometriotic lesions. P4 and E2 have been shown to modulate the expression of key neurotrophins, including nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF). This review presents current evidence on the interplay between neurotrophins and ovarian steroids in endometriosis, with a specific focus on their contribution to neuroangiogenesis and pain pathophysiology. The review includes articles in English containing the Medical Subject Headings (MeSH) terms: "endometriosis", "neurotrophins", "nerve growth factor", "brain-derived neurotrophic factor", "neuroangiogenesis", "progesterone", and "estradiol", found in the PubMed database published between 2000 and 24 May 2026. This review included a range of original research articles, systematic reviews, meta-analyses, prospective observational studies, case-control studies, and review papers, for a total of 122 articles.

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BackgroundRelugolix, an oral GnRH receptor antagonist, is effective in treating uterine myomas and endometriosis. However, concerns persist regarding the venous thromboembolism (VTE) risk associated with its combination with oral estradiol (E2) and norethisterone acetate (NETA).ObjectiveThis expert opinion evaluates the thrombotic risk of relugolix combined therapy (relugolix-CT) based on pharmacological data, clinical trials, and regulatory assessments.MethodsA review of pivotal trials (LIBERTY 1, LIBERTY 2, SPIRIT 1, SPIRIT 2), regulatory reports (European Medicines Agency, Food and Drug Administration), and real-world safety data was conducted, focusing on hemostatic effects and VTE risk.ResultsRelugolix monotherapy reduces estrogen levels, leading to minor decreases in coagulation factors. While E2 and NETA mitigate hypoestrogenic effects, concerns about their prothrombotic potential remain. However, clinical trials and postmarketing surveillance have not shown a significant increase in VTE risk. A meta-analysis suggests that E2-based regimens have a lower thrombotic risk than ethinylestradiol-based therapies.ConclusionThe VTE risk of relugolix-CT appears lower than that of traditional combined oral contraceptives. Nonetheless, patient selection is essential, particularly for those with thrombotic risk factors. Continued real-world surveillance is crucial to refining its safety profile in clinical practice.

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BackgroundEndometriosis (EMs) is a common chronic inflammatory gynecological disease that belongs to the classification of Traditional Chinese Medicine Syndromes "Zheng Jia," and the classic Chinese formula Guizhi Fuling (GZFL) demonstrates significant clinical efficacy in the treatment of this condition. This study aims to investigate GZFL's effect and potential mechanism in EMs.MethodsThe search reviewed randomized controlled trials in 7 databases from inception to 2024, assessed quality with the Cochrane tool, and analyzed data with STATA 15 by 2 reviewers. In the network pharmacology study, we searched and screened the components and targets of GZFL, subsequently compared these targets to EMs targets, and used bioinformatics techniques to analyze and explore their potential interactions.ResultsNine randomized controlled trials involving 897 participants were analyzed. Meta-analysis showed that GZFL combined with dienogest significantly enhanced the clinical effectiveness rate (odds ratio = 2.404, 95% confidence intervals [CI], 1.868 to 3.093; P ConclusionIn conclusion, GZFL combination treatment could increase the clinical effectiveness rate of EMs patients, and reduce the serum level of carbohydrate antigen 125, estradiol, matrix metalloproteinases, pain scores, and the diameter of the ectopic cyst. The potential mechanism might be linked to the modulation of hormone receptors and inflammation.

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BackgroundCombined oral contraceptives (COCs) increase venous thromboembolism (VTE) risk, depending on estrogen type, dose, and progestin. While epidemiological studies provide insight into these risks, they require years to complete. The normalized activated protein C sensitivity ratio (nAPCsr), a standardized assay of acquired activated protein C resistance, has emerged as a potential biomarker of COC-induced VTE risk.ObjectivesTo develop a population-based in silico model predicting VTE risk associated with various COC formulations based on their mean nAPCsr values.MethodsWe analyzed 200 plasma samples from non-COC users and 257 from users of 9 different COCs. We constructed an exponential model to correlate the mean nAPCsr of 5 COCs with their available population-based VTE relative risk, as extracted from a published meta-analysis. We assessed model performance using R 2, Spearman's rank correlation coefficient, and the root mean square error, and performed a sensitivity analysis by excluding COC nonusers. We then estimated population-based VTE risks for the 4 COCs not used in model construction.ResultsThe model demonstrated high predictive accuracy (R2 = .96; root mean square error = 0.21; Spearman correlation coefficient = 1) and remained robust despite group size imbalance. Predicted VTE risks for ethinylestradiol 30 μg with dienogest 2 mg, ethinylestradiol 20 μg with drospirenone 3 mg, estradiol 1.5 mg with nomegestrol acetate 2.5 mg, and estetrol 15 mg with drospirenone 3 mg were 4.36, 3.43, 1.50, and 1.45, respectively, consistent with or complementary to existing epidemiological evidence.ConclusionOur model, based on mean nAPCsr, provides a reliable, biomarker-based approach for predicting population-based COC-related VTE risk. This strategy could help shorten the time between product launch and population-based risk assessment.

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Purpose of reviewWhile laparoscopic surgery plays a key role in the management of endometriosis, symptoms commonly recur, and repeat surgery comes with increased risk. Medical management, including hormonal and nonhormonal treatment, is vital in managing painful symptoms. This review summarizes recent evidence regarding various medical management options available to treat pelvic pain associated with endometriosis.Recent findingsEfficacy of dienogest vs. combined oral contraceptive on pain associated with endometriosis: randomized clinical trial.Once daily oral relugolix combination therapy vs. placebo in patients with endometriosis-associated pain: two replicate phase 3, randomised, double-blind, studies (SPIRIT 1 and 2).A randomized, double-blind, placebo-controlled pilot study of the comparative effects of dienogest and the combined oral contraceptive pill in women with endometriosis.Two-year efficacy and safety of relugolix combination therapy in women with endometriosis-associated pain: SPIRIT open-label extension study.SummaryAll symptomatic women with suspected endometriosis who are not desiring immediate fertility can be offered suppressive treatment to control symptoms and slow the progression of disease. First-line treatments include the combined oral contraceptive pill and progestogens. Second-line treatments include gonadotropin-releasing hormone agonists and antagonists but current guidelines recommend that these should be reserved for people whose symptoms fail to be controlled by first-line agents. The use of complementary and alternative medicines is also increasing in both volume and number of agents used.

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