European journal of obstetrics, gynecology, and reproductive biology · 2026
Effectiveness of estetrol 15 mg combined with drospirenone 3 mg for symptom control in women with endometriosis: a systematic review.
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Leitão Manuela Oliveira, Rodrigues de Sousa Frederico Timm, Cunha Gabriela Reis, Tavares Lara Vieira, Lunardi Rocha Ana Luiza, Fontes de Oliveira Elaine Cristina
Аннотация
OBJECTIVE: To systematically evaluate the effectiveness of estetrol (E4) combined with drospirenone (DRSP) in reducing endometriosis-related symptoms and improving quality of life (QoL).
STUDY DESIGN: We conducted a systematic review in accordance with Cochrane Collaboration guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Two reviewers independently performed study selection, data extraction, and risk of bias assessment. A third author resolved disagreements between the reviewers. We conducted a comprehensive search across PubMed, Embase, and Cochrane Central Register of Controlled Trials, without language or date restrictions.
MAIN FINDINGS: We included two RCTs and two observational cohorts, encompassing a total of 198 patients. Quantitative synthesis was not feasible for the outcomes due to the limited number of eligible studies and the lack of sufficient comparable data. E4/DRSP demonstrated a significant reduction in pelvic pain compared with placebo, whereas no significant differences were observed when compared with other active hormonal regimens. Treatment with E4/DRSP also was associated with clinically meaningful improvements in dysmenorrhea symptoms. Furthermore, E4/DRSP improved QoL in women with endometriosis, with improvements in sleep quality, patient- and clinician-reported global improvement and overall health status. The findings regarding dyspareunia were inconsistent. The most common adverse effect was intermenstrual bleeding/spotting.
CONCLUSION: Based on the current evidence, E4/DRSP appears to be a promising option for the management of endometriosis-related symptoms, particularly improving pelvic pain, dysmenorrhea, and QoL.
IMPLICATIONS: This systematic review, conducted according to Cochrane and PRISMA guidelines, indicated that E4/DRSP may be effective in reducing endometriosis-associated symptoms, although its superiority over other combined hormonal contraceptives remains uncertain.
STUDY DESIGN: We conducted a systematic review in accordance with Cochrane Collaboration guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Two reviewers independently performed study selection, data extraction, and risk of bias assessment. A third author resolved disagreements between the reviewers. We conducted a comprehensive search across PubMed, Embase, and Cochrane Central Register of Controlled Trials, without language or date restrictions.
MAIN FINDINGS: We included two RCTs and two observational cohorts, encompassing a total of 198 patients. Quantitative synthesis was not feasible for the outcomes due to the limited number of eligible studies and the lack of sufficient comparable data. E4/DRSP demonstrated a significant reduction in pelvic pain compared with placebo, whereas no significant differences were observed when compared with other active hormonal regimens. Treatment with E4/DRSP also was associated with clinically meaningful improvements in dysmenorrhea symptoms. Furthermore, E4/DRSP improved QoL in women with endometriosis, with improvements in sleep quality, patient- and clinician-reported global improvement and overall health status. The findings regarding dyspareunia were inconsistent. The most common adverse effect was intermenstrual bleeding/spotting.
CONCLUSION: Based on the current evidence, E4/DRSP appears to be a promising option for the management of endometriosis-related symptoms, particularly improving pelvic pain, dysmenorrhea, and QoL.
IMPLICATIONS: This systematic review, conducted according to Cochrane and PRISMA guidelines, indicated that E4/DRSP may be effective in reducing endometriosis-associated symptoms, although its superiority over other combined hormonal contraceptives remains uncertain.