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Cochrane Database of Systematic Reviews

Oral contraceptives for pain associated with endometriosis

Information

DOI:
https://doi.org/10.1002/14651858.CD001019.pub3Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 22 May 2018see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Gynaecology and Fertility Group

Copyright:
  1. Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Julie Brown

    Correspondence to: Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand

    [email protected]

  • Tineke J Crawford

    Liggins Institute, The University of Auckland, Auckland, New Zealand

  • Shree Datta

    King's College Hospital NHS Foundation Trust, London, UK

  • Andrew Prentice

    Department of Obstetrics and Gynaecology, Rosie Hospital, University of Cambridge Clinical School, Cambridge, UK

Contributions of authors

JB, AP, TC: identified the trials for inclusion, extracted and entered data, and assessed trials for risk of bias.

SD and AP were available for content expertise, to assist with any disagreements in assessment by JB and TC, and both made comments and contributions to draft and final versions of the review update.

Sources of support

Internal sources

  • AP: University of Cambridge, UK.

  • JM and SK: University of Oxford, UK.

External sources

  • LJD Peninsula Medical School Foundation Bursary, UK.

  • LJD National Birthday Trust Fund, Wellbeing of Women, UK.

Declarations of interest

JB: none known.

TC: none known.

SD: none known.

AP: none known.

Acknowledgements

Thank you to the editorial base in Auckland.

2018 update: We would like to acknowledge the contributions of L‐J Davis, SS Kennedy and J Moore to previous versions of this review.

Version history

Published

Title

Stage

Authors

Version

2018 May 22

Oral contraceptives for pain associated with endometriosis

Review

Julie Brown, Tineke J Crawford, Shree Datta, Andrew Prentice

https://doi.org/10.1002/14651858.CD001019.pub3

2007 Jul 18

Oral contraceptives for pain associated with endometriosis

Review

Lucy‐Jane Davis, Stephen S Kennedy, Jane Moore, Andrew Prentice

https://doi.org/10.1002/14651858.CD001019.pub2

1997 Oct 20

Modern combined oral contraceptives for pain associated with endometriosis

Review

Jane Moore, Stephen S Kennedy, Andrew Prentice

https://doi.org/10.1002/14651858.CD001019

Differences between protocol and review

In the 2018 update of this review we:

  • removed the restriction on the duration of treatment that was previously an exclusion for participants;

  • changed the presentation of data from odds ratio to risk ratios for dichotomous data to comply with current Cochrane Gynaecology and Fertility Group guidance;

  • changed the primary outcome from "Pain symptoms of endometriosis and dysmenorrhoea: recurrence, frequency and severity (pain scores, days lost off work, use of pain killers)" to "self‐reported pain (dysmenorrhoea) at the end of treatment (as defined by trialists)."

  • In the 'Participants' section we clarified that trials reporting on women with endometrial deposits outside the uterus were excluded.

Keywords

MeSH

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
Figures and Tables -
Figure 2

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
Figures and Tables -
Figure 3

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

Forest plot of comparison: 1 Combined oral contractive pill (COCP) versus placebo/no treatment, outcome: 1.1 Self‐reported pain (dysmenorrhoea) at end of treatment.
Figures and Tables -
Figure 4

Forest plot of comparison: 1 Combined oral contractive pill (COCP) versus placebo/no treatment, outcome: 1.1 Self‐reported pain (dysmenorrhoea) at end of treatment.

Forest plot of comparison: 2 Combined oral contractive pill (COCP) versus other medical treatment, outcome: 2.1 Self‐reported pain (dysmenorrhoea) at end of treatment (continuous data).
Figures and Tables -
Figure 5

Forest plot of comparison: 2 Combined oral contractive pill (COCP) versus other medical treatment, outcome: 2.1 Self‐reported pain (dysmenorrhoea) at end of treatment (continuous data).

Forest plot of comparison: 2 Combined oral contractive pill (COCP) versus other medical treatment, outcome: 2.2 Self‐reported pain (dysmenorrhoea): VAS (dichotomous data).
Figures and Tables -
Figure 6

Forest plot of comparison: 2 Combined oral contractive pill (COCP) versus other medical treatment, outcome: 2.2 Self‐reported pain (dysmenorrhoea): VAS (dichotomous data).

Forest plot of comparison: 2 Combined oral contractive pill (COCP) versus other medical treatment, outcome: 2.3 Self‐reported pain (dysmenorrhoea): VRS (dichotomous data).
Figures and Tables -
Figure 7

Forest plot of comparison: 2 Combined oral contractive pill (COCP) versus other medical treatment, outcome: 2.3 Self‐reported pain (dysmenorrhoea): VRS (dichotomous data).

Comparison 1 Combined oral contractive pill (COCP) versus placebo/no treatment, Outcome 1 Self‐reported pain (dysmenorrhoea) at end of treatment.
Figures and Tables -
Analysis 1.1

Comparison 1 Combined oral contractive pill (COCP) versus placebo/no treatment, Outcome 1 Self‐reported pain (dysmenorrhoea) at end of treatment.

Comparison 1 Combined oral contractive pill (COCP) versus placebo/no treatment, Outcome 2 Cyclical pain (non‐menstrual).
Figures and Tables -
Analysis 1.2

Comparison 1 Combined oral contractive pill (COCP) versus placebo/no treatment, Outcome 2 Cyclical pain (non‐menstrual).

Comparison 1 Combined oral contractive pill (COCP) versus placebo/no treatment, Outcome 3 Dyspareunia.
Figures and Tables -
Analysis 1.3

Comparison 1 Combined oral contractive pill (COCP) versus placebo/no treatment, Outcome 3 Dyspareunia.

Comparison 1 Combined oral contractive pill (COCP) versus placebo/no treatment, Outcome 4 Dyschezia (pain on defecation).
Figures and Tables -
Analysis 1.4

Comparison 1 Combined oral contractive pill (COCP) versus placebo/no treatment, Outcome 4 Dyschezia (pain on defecation).

Comparison 1 Combined oral contractive pill (COCP) versus placebo/no treatment, Outcome 5 Satisfaction (very highly/highly satisfied).
Figures and Tables -
Analysis 1.5

Comparison 1 Combined oral contractive pill (COCP) versus placebo/no treatment, Outcome 5 Satisfaction (very highly/highly satisfied).

Comparison 1 Combined oral contractive pill (COCP) versus placebo/no treatment, Outcome 6 Withdrawal from treatment.
Figures and Tables -
Analysis 1.6

Comparison 1 Combined oral contractive pill (COCP) versus placebo/no treatment, Outcome 6 Withdrawal from treatment.

Comparison 1 Combined oral contractive pill (COCP) versus placebo/no treatment, Outcome 7 Adverse effects occurring during treatment.
Figures and Tables -
Analysis 1.7

Comparison 1 Combined oral contractive pill (COCP) versus placebo/no treatment, Outcome 7 Adverse effects occurring during treatment.

Comparison 2 Combined oral contractive pill (COCP) versus other medical treatment, Outcome 1 Self‐reported pain (dysmenorrhoea) at end of treatment (continuous data).
Figures and Tables -
Analysis 2.1

Comparison 2 Combined oral contractive pill (COCP) versus other medical treatment, Outcome 1 Self‐reported pain (dysmenorrhoea) at end of treatment (continuous data).

Comparison 2 Combined oral contractive pill (COCP) versus other medical treatment, Outcome 2 Self‐reported pain (dysmenorrhoea): VAS (dichotomous data).
Figures and Tables -
Analysis 2.2

Comparison 2 Combined oral contractive pill (COCP) versus other medical treatment, Outcome 2 Self‐reported pain (dysmenorrhoea): VAS (dichotomous data).

Comparison 2 Combined oral contractive pill (COCP) versus other medical treatment, Outcome 3 Self‐reported pain (dysmenorrhoea): VRS (dichotomous data).
Figures and Tables -
Analysis 2.3

Comparison 2 Combined oral contractive pill (COCP) versus other medical treatment, Outcome 3 Self‐reported pain (dysmenorrhoea): VRS (dichotomous data).

Comparison 2 Combined oral contractive pill (COCP) versus other medical treatment, Outcome 4 Cyclical pain (non‐menstrual pain) (continuous data).
Figures and Tables -
Analysis 2.4

Comparison 2 Combined oral contractive pill (COCP) versus other medical treatment, Outcome 4 Cyclical pain (non‐menstrual pain) (continuous data).

Comparison 2 Combined oral contractive pill (COCP) versus other medical treatment, Outcome 5 Cyclical pain (non‐menstrual pain) (dichotomous data).
Figures and Tables -
Analysis 2.5

Comparison 2 Combined oral contractive pill (COCP) versus other medical treatment, Outcome 5 Cyclical pain (non‐menstrual pain) (dichotomous data).

Comparison 2 Combined oral contractive pill (COCP) versus other medical treatment, Outcome 6 Dyspareunia (continuous data).
Figures and Tables -
Analysis 2.6

Comparison 2 Combined oral contractive pill (COCP) versus other medical treatment, Outcome 6 Dyspareunia (continuous data).

Comparison 2 Combined oral contractive pill (COCP) versus other medical treatment, Outcome 7 Dyspareunia (dichotomous data).
Figures and Tables -
Analysis 2.7

Comparison 2 Combined oral contractive pill (COCP) versus other medical treatment, Outcome 7 Dyspareunia (dichotomous data).

Comparison 2 Combined oral contractive pill (COCP) versus other medical treatment, Outcome 8 Withdrawal from treatment.
Figures and Tables -
Analysis 2.8

Comparison 2 Combined oral contractive pill (COCP) versus other medical treatment, Outcome 8 Withdrawal from treatment.

Comparison 2 Combined oral contractive pill (COCP) versus other medical treatment, Outcome 9 Adverse effects.
Figures and Tables -
Analysis 2.9

Comparison 2 Combined oral contractive pill (COCP) versus other medical treatment, Outcome 9 Adverse effects.

Summary of findings for the main comparison. Combined oral contraceptive pill compared to placebo or no treatment for pain associated with endometriosis

Combined oral contraceptive pill (COCP) compared to placebo/no treatment for pain associated with endometriosis

Patient or population: women with endometriosis
Setting: Japan
Intervention: COCP
Comparison: placebo

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with placebo/no treatment

Risk with COCP

Self‐reported pain (dysmenorrhoea) at the end of treatment: dysmenorrhoea VRS

The mean self‐reported pain (dysmenorrhoea) at the end of treatment: Dysmenorrhoea VRS was 3.7

MD 1.3 lower
(1.84 lower to 0.76 lower)

96
(1 RCT)

⊕⊝⊝⊝
Very low1,2

VRS ranged from 0 to 3.

Self‐reported pain (dysmenorrhoea) at the end of treatment: dysmenorrhoea VAS

The mean self‐reported pain (dysmenorrhoea) at the end of treatment: Dysmenorrhoea VAS was 46.2

MD 23.68 lower
(28.75 lower to 18.62 lower)

327
(2 RCTs)

⊕⊝⊝⊝
Very low2,3

No details provided for the VAS.

Self‐reported pain: menstrual pain reduction from baseline to end of treatment

The mean menstrual pain (reduction from baseline to end of treatment) was 3.00

MD 2.10 lower (1.38 lower to 2.82 lower)

169

(1 RCT)

⊕⊝⊝⊝
Very low1,2

Used a VAS from 0 to 10 where 10 was extreme pain.

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; COCP: combined oral contraceptive pill; MD: mean difference; RCT: randomised controlled trial; VAS: visual analogue scale; VRS: verbal rating scale.

GRADE Working Group grades of evidence
High quality: we are very confident that the true effect lies close to that of the estimate of the effect.
Moderate quality: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low quality: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
Very low quality: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.

1Imprecision: evidence was based on a single small trial; downgraded one level.

2Risk of bias: trial judged to be at high risk of bias; downgraded two levels.

3Imprecision: evidence based on a single trial including 96 women; wide confidence intervals; downgraded two levels.

Figures and Tables -
Summary of findings for the main comparison. Combined oral contraceptive pill compared to placebo or no treatment for pain associated with endometriosis
Summary of findings 2. Combined oral contraceptive pill compared to other medical treatment for pain associated with endometriosis

Combined oral contraceptive pill (COCP) compared to other medical treatment for pain associated with endometriosis

Patient or population: women with endometriosis
Setting: Italy
Intervention: COCP
Comparison: other medical treatment (goserelin)

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with other medical treatment

Risk with COCP

Self‐reported pain (dysmenorrhoea) at the end of treatment (continuous data): dysmenorrhoea at 6 months' follow‐up: VAS

The mean self‐reported pain (dysmenorrhoea) at the end of treatment (continuous data): dysmenorrhoea at 6 months' follow‐up was 7.5

MD 0.1 lower
(1.28 lower to 1.08 higher)

50
(1 RCT)

⊕⊝⊝⊝
Very low1,2

VAS ranged from 1 to 10.

Self‐reported pain (dysmenorrhoea) at the end of treatment (continuous data): dysmenorrhoea at 6 months' follow‐up: VRS

The mean self‐reported pain (dysmenorrhoea) at the end of treatment (continuous data): dysmenorrhoea at 6 months' follow‐up was 4.8

MD 0.1 lower
(0.99 lower to 0.79 higher)

50
(1 RCT)

⊕⊝⊝⊝
Very low1,2

VRS ranged from 0 to 3.

Self‐reported pain (dysmenorrhoea) (dichotomous data): reduction of pain to zero at 6 months' follow‐up: VAS

38 per 1000

14 per 1000
(1 to 324)

RR 0.36
(0.02 to 8.43)

50
(1 RCT)

⊕⊝⊝⊝
Very low1,2

VAS ranged from 1 to 10.

Self‐reported pain (dysmenorrhoea) (dichotomous data) ‐ reduction of pain to zero at 6 months' follow‐up: VRS

1000 per 1000

1000 per 1000
(930 to 1000)

RR 1.00
(0.93 to 1.08)

49
(1 RCT)

⊕⊕⊝⊝
Low1,3

VRS ranged from 0 to 3.

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; COCP: combined oral contraceptive pill; MD: mean difference; RCT: randomised controlled trial; RR: risk ratio; VAS: visual analogue scale; VRS: verbal rating scale.

GRADE Working Group grades of evidence
High quality: we are very confident that the true effect lies close to that of the estimate of the effect.
Moderate quality: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low quality: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
Very low quality: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.

1Risk of bias: no blinding and randomisation and allocation concealment unclear; downgraded one level.

2Imprecision: evidence from a single small trial including 50 women; wide confidence intervals crossing the line of no effect; downgraded two levels.

3Imprecision: evidence from a single small trial reporting data on 49 women; downgraded one level.

Figures and Tables -
Summary of findings 2. Combined oral contraceptive pill compared to other medical treatment for pain associated with endometriosis
Comparison 1. Combined oral contractive pill (COCP) versus placebo/no treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Self‐reported pain (dysmenorrhoea) at end of treatment Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

1.1 Dysmenorrhoea at end of treatment: verbal rating scale (VRS)

1

96

Mean Difference (IV, Fixed, 95% CI)

‐1.30 [‐1.84, ‐0.76]

1.2 Dysmenorrhoea at end of treatment: visual analogue scale (VAS)

2

327

Mean Difference (IV, Fixed, 95% CI)

‐23.68 [‐28.75, ‐18.62]

1.3 Menstrual pain reduction from baseline to end of treatment: VAS)

1

169

Mean Difference (IV, Fixed, 95% CI)

2.1 [1.38, 2.82]

2 Cyclical pain (non‐menstrual) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

2.1 Non‐menstrual pain at end of treatment: VRS

1

96

Mean Difference (IV, Fixed, 95% CI)

0.10 [‐0.48, 0.68]

2.2 Non‐menstrual pain at end of treatment: VAS

1

96

Mean Difference (IV, Fixed, 95% CI)

‐1.90 [‐11.72, 7.92]

2.3 Non‐menstrual pain reduction from baseline to end of treatment: VAS

1

212

Mean Difference (IV, Fixed, 95% CI)

1.00 [0.30, 1.70]

3 Dyspareunia Show forest plot

1

89

Mean Difference (IV, Fixed, 95% CI)

1.4 [0.46, 2.34]

4 Dyschezia (pain on defecation) Show forest plot

1

231

Mean Difference (IV, Fixed, 95% CI)

1.2 [0.56, 1.84]

5 Satisfaction (very highly/highly satisfied) Show forest plot

1

258

Risk Ratio (M‐H, Fixed, 95% CI)

4.24 [2.44, 7.37]

6 Withdrawal from treatment Show forest plot

2

354

Risk Ratio (M‐H, Fixed, 95% CI)

1.34 [0.83, 2.18]

7 Adverse effects occurring during treatment Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 Pregnancy

1

96

Risk Ratio (M‐H, Fixed, 95% CI)

2.88 [0.12, 68.98]

7.2 Spotting/irregular bleeding/menorrhagia

2

354

Risk Ratio (M‐H, Fixed, 95% CI)

2.44 [1.44, 4.15]

7.3 Nausea

2

354

Risk Ratio (M‐H, Fixed, 95% CI)

4.14 [1.79, 9.54]

7.4 Any treatment‐associated adverse effect

1

258

Risk Ratio (M‐H, Fixed, 95% CI)

1.17 [1.00, 1.36]

Figures and Tables -
Comparison 1. Combined oral contractive pill (COCP) versus placebo/no treatment
Comparison 2. Combined oral contractive pill (COCP) versus other medical treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Self‐reported pain (dysmenorrhoea) at end of treatment (continuous data) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

1.1 Dysmenorrhoea at 6 months' follow‐up: visual analogue scale (VAS)

1

50

Mean Difference (IV, Fixed, 95% CI)

‐0.10 [‐1.28, 1.08]

1.2 Dysmenorrhoea at 6 months' follow‐up: verbal rating scale (VRS)

1

50

Mean Difference (IV, Fixed, 95% CI)

‐0.10 [‐0.99, 0.79]

2 Self‐reported pain (dysmenorrhoea): VAS (dichotomous data) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 Reduction of pain to mild or zero at 6 months' follow‐up

1

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.90 [0.32, 2.58]

2.2 Reduction of pain to zero at 6 months' follow‐up

1

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.36 [0.02, 8.43]

3 Self‐reported pain (dysmenorrhoea): VRS (dichotomous data) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Reduction of pain to mild or zero at 6 months' follow‐up

1

44

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.70, 1.28]

3.2 Reduction of pain to zero at 6 months' follow‐up

1

49

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.93, 1.08]

4 Cyclical pain (non‐menstrual pain) (continuous data) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

4.1 Non‐menstrual pain at end of treatment: VAS

1

50

Mean Difference (IV, Fixed, 95% CI)

‐0.20 [‐1.51, 1.11]

4.2 Non‐menstrual pain at end of treatment: VRS

1

50

Mean Difference (IV, Fixed, 95% CI)

0.40 [‐0.51, 1.31]

4.3 Non‐menstrual pain at 6 months' follow‐up: VAS

1

50

Mean Difference (IV, Fixed, 95% CI)

‐0.30 [‐1.85, 1.25]

4.4 Non‐menstrual pain at 6 months' follow‐up: VRS

1

50

Mean Difference (IV, Fixed, 95% CI)

0.0 [‐1.08, 1.08]

5 Cyclical pain (non‐menstrual pain) (dichotomous data) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 Reduction of pain to mild or zero at end of treatment: VAS

1

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.81, 1.21]

5.2 Reduction of pain to zero at end of treatment: VAS

1

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.51, 1.89]

5.3 Reduction of pain to mild or zero at end of treatment: VRS

1

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.84, 1.17]

5.4 Reduction to zero at end of treatment: VRS

1

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.51, 1.89]

5.5 Reduction of pain to mild or zero at 6 months' follow‐up: VAS

1

50

Risk Ratio (M‐H, Fixed, 95% CI)

1.14 [0.85, 1.53]

5.6 Reduction of pain to zero at 6 months' follow‐up: VAS

1

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.87 [0.26, 2.85]

5.7 Reduction of pain to mild or zero at 6 months' follow‐up: VRS

1

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.91 [0.63, 1.32]

5.8 Reduction of pain to zero at 6 months' follow‐up: VRS

1

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.87 [0.26, 2.85]

6 Dyspareunia (continuous data) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

6.1 Dyspareunia at end of treatment: VAS

1

43

Mean Difference (IV, Fixed, 95% CI)

1.80 [0.18, 3.42]

6.2 Dyspareunia at end of treatment: VRS

1

43

Mean Difference (IV, Fixed, 95% CI)

0.10 [‐0.41, 0.61]

6.3 Dyspareunia at 6 months' follow‐up: VAS

1

43

Mean Difference (IV, Fixed, 95% CI)

0.40 [‐1.30, 2.10]

6.4 Dyspareunia at 6 months' follow‐up: VRS

1

43

Mean Difference (IV, Fixed, 95% CI)

0.10 [‐0.47, 0.67]

7 Dyspareunia (dichotomous data) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 Reduction of pain to mild or zero at end of treatment: VAS

1

43

Risk Ratio (M‐H, Fixed, 95% CI)

0.73 [0.53, 1.02]

7.2 Reduction of pain to zero at end of treatment: VAS

1

43

Risk Ratio (M‐H, Fixed, 95% CI)

0.52 [0.19, 1.48]

7.3 Reduction of pain to mild or zero at end of treatment: VRS

1

25

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.56, 1.65]

7.4 Reduction of pain to zero at end of treatment: VRS

1

38

Risk Ratio (M‐H, Fixed, 95% CI)

1.35 [0.99, 1.84]

7.5 Reduction of pain to mild or zero at 6 months' follow‐up: VAS

1

43

Risk Ratio (M‐H, Fixed, 95% CI)

1.05 [0.62, 1.78]

7.6 Reduction of pain to zero at 6 months' follow‐up: VAS

1

43

Risk Ratio (M‐H, Fixed, 95% CI)

0.70 [0.13, 3.77]

7.7 Reduction of pain to mild or zero at 6 months' follow‐up: VRS

1

43

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.55, 1.68]

7.8 Reduction of pain to zero at 6 months' follow‐up: VRS

1

43

Risk Ratio (M‐H, Fixed, 95% CI)

0.70 [0.13, 3.77]

8 Withdrawal from treatment Show forest plot

1

57

Risk Ratio (M‐H, Fixed, 95% CI)

1.38 [0.34, 5.62]

9 Adverse effects Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

9.1 Hot flushes

1

57

Risk Ratio (M‐H, Fixed, 95% CI)

0.04 [0.01, 0.30]

9.2 Insomnia

1

57

Risk Ratio (M‐H, Fixed, 95% CI)

0.07 [0.00, 1.15]

9.3 Spotting/irregular bleeding

1

57

Risk Ratio (M‐H, Fixed, 95% CI)

1.21 [0.46, 3.15]

9.4 Decreased libido

1

57

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.22, 2.19]

9.5 Vaginal dryness

1

57

Risk Ratio (M‐H, Fixed, 95% CI)

0.09 [0.01, 1.63]

9.6 Mood change

1

57

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.34, 3.19]

9.7 Headache

1

57

Risk Ratio (M‐H, Fixed, 95% CI)

1.55 [0.49, 4.92]

9.8 Paraesthesia

1

57

Risk Ratio (M‐H, Fixed, 95% CI)

0.35 [0.04, 3.12]

9.9 Breast tenderness

1

57

Risk Ratio (M‐H, Fixed, 95% CI)

1.73 [0.45, 6.55]

9.10 Weight gain

1

57

Risk Ratio (M‐H, Fixed, 95% CI)

2.07 [0.41, 10.43]

9.11 Peripheral oedema

1

57

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.07, 15.77]

9.12 Joint pain

1

57

Risk Ratio (M‐H, Fixed, 95% CI)

0.34 [0.01, 8.12]

Figures and Tables -
Comparison 2. Combined oral contractive pill (COCP) versus other medical treatment