Exploring Short-Acting Hormonal Contraceptives in Endometriosis Care-A Narrative Review and Evidence-Based Practical
M Ángeles Martínez-Zamora1,2, Josep Perelló-Capó3,4, Joaquim Calaf-Alsina3,5
1Gynecology Department, Clínic Institute of Gyneacology, Obstetrics and Neonatology (ICGON), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.
Background:
Endometriosis is a chronic, estrogen-dependent inflammatory condition affecting approximately 10% of women of reproductive age and manifesting with pelvic pain, dysmenorrhea, dyspareunia, fatigue, and infertility. First-line treatment in most patients is hormonal therapy, and among the available options, contraceptives are frequently used. Short-acting contraceptives (SACs) have been employed off-label to manage endometriosis-related symptoms, yet comparative evidence regarding optimal formulations and regimens remains limited. This narrative review, part of the Agnodice Project, aims to synthesize recent evidence on the SAC formulation-specific effectiveness for endometriosis management, and to provide evidence-based practical considerations for endometriosis management.
Methods:
A literature search of systematic reviews and/or meta-analyses providing data on non-contraceptive clinical benefits of SAC versus other SAC or SAC vs placebo or no treatment, including the period from 2014 to 2024, was conducted. Information was extracted as individual items related to endometriosis.
Results:
Of 86 studies included in the Agnodice Project, 10 systematic reviews and meta-analyses specifically addressed endometriosis, yielding 21 comparative items with significant differences. SACs effectively reduced dysmenorrhea, chronic pelvic pain, and post-operative endometrioma recurrence, among others. Continuous regimens consistently outperformed cyclic schedules for pain control and quality of life. Among formulations, desogestrel monotherapy was superior across multiple outcomes in women with endometriosis. Furthermore, we present practical, expert considerations based on the synthesized evidence.
Conclusions:
SACs represent valuable first-line therapeutic options for endometriosis symptom management, with continuous regimens providing optimal symptom control and recurrence prevention. Formulation selection should be individualized based on symptom profile, safety profile, comorbidities, estrogen tolerance, and patient preference.
Related Concept Videos
01:21Intrauterine Drug Delivery Systems
01:22Birth Control Methods
01:22Hormonal Regulation of the Menstrual Cycle
At puberty, GnRH begins a pulsatile release pattern, which triggers the anterior pituitary gland to secrete follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The frequency and amplitude of GnRH pulses vary across the menstrual cycle, with faster pulses favoring LH release and slower pulses favoring FSH release.
01:30Hormonal Control of the Ovarian Cycle
Before puberty, the hypothalamus releases GnRH in a low frequency, low amplitude pulsatile manner. This along with the immature hypothalamic-pituitary-gonadal axis activity, results in low estrogen levels and the absence of a fully functional ovarian cycle. At puberty, GnRH secretion increases in both frequency and...