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Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
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Figure 1

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.
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Figure 2

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

Forest plot of comparison: 1 Combined OCP versus placebo or no treatment, outcome: 1.1 Pain improvement.
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Figure 3

Forest plot of comparison: 1 Combined OCP versus placebo or no treatment, outcome: 1.1 Pain improvement.

Forest plot of comparison: 1 Combined OCP versus placebo or no treatment, outcome: 1.2 Pain score (mean change).
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Figure 4

Forest plot of comparison: 1 Combined OCP versus placebo or no treatment, outcome: 1.2 Pain score (mean change).

Forest plot of comparison: 1 Combined OCP versus placebo or no treatment, outcome: 1.3 Additional analgesia required.
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Figure 5

Forest plot of comparison: 1 Combined OCP versus placebo or no treatment, outcome: 1.3 Additional analgesia required.

Forest plot of comparison: 1 Combined OCP versus placebo or no treatment, outcome: 1.4 Absence from school or work.
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Figure 6

Forest plot of comparison: 1 Combined OCP versus placebo or no treatment, outcome: 1.4 Absence from school or work.

Forest plot of comparison: 1 Combined OCP versus placebo or no treatment, outcome: 1.5 Withdrawals from treatment.
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Figure 7

Forest plot of comparison: 1 Combined OCP versus placebo or no treatment, outcome: 1.5 Withdrawals from treatment.

Forest plot of comparison: 1 Combined OCP versus placebo or no treatment, outcome: 1.6 Adverse events.
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Figure 8

Forest plot of comparison: 1 Combined OCP versus placebo or no treatment, outcome: 1.6 Adverse events.

Forest plot of comparison: 2 Combined low dose OCP versus Combined low doseOCP, outcome: 2.1 Pain improvement.
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Figure 9

Forest plot of comparison: 2 Combined low dose OCP versus Combined low doseOCP, outcome: 2.1 Pain improvement.

Forest plot of comparison: 2 Combined low dose OCP versus Combined low doseOCP, outcome: 2.2 Withdrawals from treatment.
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Figure 10

Forest plot of comparison: 2 Combined low dose OCP versus Combined low doseOCP, outcome: 2.2 Withdrawals from treatment.

Comparison 1 Combined OCP versus placebo or no treatment, Outcome 1 Pain improvement.
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Analysis 1.1

Comparison 1 Combined OCP versus placebo or no treatment, Outcome 1 Pain improvement.

Comparison 1 Combined OCP versus placebo or no treatment, Outcome 2 Pain score (mean change).
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Analysis 1.2

Comparison 1 Combined OCP versus placebo or no treatment, Outcome 2 Pain score (mean change).

Comparison 1 Combined OCP versus placebo or no treatment, Outcome 3 Additional analgesia required.
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Analysis 1.3

Comparison 1 Combined OCP versus placebo or no treatment, Outcome 3 Additional analgesia required.

Comparison 1 Combined OCP versus placebo or no treatment, Outcome 4 Absence from school or work.
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Analysis 1.4

Comparison 1 Combined OCP versus placebo or no treatment, Outcome 4 Absence from school or work.

Comparison 1 Combined OCP versus placebo or no treatment, Outcome 5 Withdrawals from treatment.
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Analysis 1.5

Comparison 1 Combined OCP versus placebo or no treatment, Outcome 5 Withdrawals from treatment.

Comparison 1 Combined OCP versus placebo or no treatment, Outcome 6 Adverse events.
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Analysis 1.6

Comparison 1 Combined OCP versus placebo or no treatment, Outcome 6 Adverse events.

Comparison 2 Combined low dose OCP versus Combined low doseOCP, Outcome 1 Pain improvement.
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Analysis 2.1

Comparison 2 Combined low dose OCP versus Combined low doseOCP, Outcome 1 Pain improvement.

Comparison 2 Combined low dose OCP versus Combined low doseOCP, Outcome 2 Withdrawals from treatment.
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Analysis 2.2

Comparison 2 Combined low dose OCP versus Combined low doseOCP, Outcome 2 Withdrawals from treatment.

Comparison 1. Combined OCP versus placebo or no treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain improvement Show forest plot

7

497

Odds Ratio (M‐H, Fixed, 95% CI)

2.01 [1.32, 3.08]

1.1 low dose oestrogen and 1st/2nd generation progestagen

1

76

Odds Ratio (M‐H, Fixed, 95% CI)

1.83 [0.69, 4.83]

1.2 low dose oestrogen and 3rd generation progestagen

1

73

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.3 medium dose oestrogen and 1st/2nd generation progestagen

5

348

Odds Ratio (M‐H, Fixed, 95% CI)

2.06 [1.28, 3.30]

2 Pain score (mean change) Show forest plot

2

150

Mean Difference (IV, Fixed, 95% CI)

‐0.29 [‐0.46, ‐0.12]

2.1 Low dose oestrogen and 1st/2nd generation progesterone

1

74

Mean Difference (IV, Fixed, 95% CI)

1.50 [‐0.78, 3.78]

2.2 Low dose oestrogen and 3rd generation progestagen

1

76

Mean Difference (IV, Fixed, 95% CI)

‐0.3 [‐0.47, ‐0.13]

2.3 Medium dose oestrogen and 1st/2nd generation progestagen

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Additional analgesia required Show forest plot

2

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 low dose oestrogen and 1st/2nd generation progestagen

1

74

Odds Ratio (M‐H, Fixed, 95% CI)

0.33 [0.13, 0.85]

3.2 low dose oestrogen and 3rd generation progestagen

0

0

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.3 medium dose oestrogen and 1st/2nd generation progestagen

1

89

Odds Ratio (M‐H, Fixed, 95% CI)

1.76 [0.66, 4.72]

4 Absence from school or work Show forest plot

2

148

Odds Ratio (M‐H, Fixed, 95% CI)

0.39 [0.17, 0.88]

4.1 low dose oestrogen and 1st/2nd generation progestagen

1

59

Odds Ratio (M‐H, Fixed, 95% CI)

0.18 [0.01, 3.92]

4.2 medium dose oestrogen and 1st/2nd generation progestagen

1

89

Odds Ratio (M‐H, Fixed, 95% CI)

0.42 [0.18, 0.99]

5 Withdrawals from treatment Show forest plot

2

134

Odds Ratio (M‐H, Fixed, 95% CI)

2.06 [0.18, 23.72]

5.1 low dose oestrogen and 1st/2nd generation progestagen

1

74

Odds Ratio (M‐H, Fixed, 95% CI)

2.06 [0.18, 23.72]

5.2 low dose estrogen and 3rd generation progestagen

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.3 medium dose oestrogen and 1st/2nd generation progestagen

0

0

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Adverse events Show forest plot

3

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 Nausea

3

225

Odds Ratio (M‐H, Fixed, 95% CI)

0.91 [0.41, 2.03]

6.2 Headaches

2

135

Odds Ratio (M‐H, Fixed, 95% CI)

1.56 [0.67, 3.67]

6.3 Weight gain

1

76

Odds Ratio (M‐H, Fixed, 95% CI)

2.17 [0.71, 6.65]

6.4 Experienced any side effect

2

165

Odds Ratio (M‐H, Fixed, 95% CI)

1.45 [0.71, 2.94]

Figures and Tables -
Comparison 1. Combined OCP versus placebo or no treatment
Comparison 2. Combined low dose OCP versus Combined low doseOCP

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain improvement Show forest plot

3

Peto Odds Ratio (Peto, Fixed, 95% CI)

Subtotals only

1.1 3rd generation progestagens: 75mcg gestodene vs150mcg desogestrel

2

626

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.11 [0.79, 1.57]

1.2 2nd generation versus 3rd generation progestagens100mcg levonorgestrel vs 150mcg desogestrel

1

349

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.44 [0.23, 0.84]

2 Withdrawals from treatment Show forest plot

3

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 3rd generation progestagens: 75mcg gestodene vs150mcg desogestrel

2

626

Odds Ratio (M‐H, Fixed, 95% CI)

1.15 [0.72, 1.83]

2.2 2nd generation versus 3rd generation progestagens: 100mcg levonorgestrel vs 150mcg desogestrel

1

349

Odds Ratio (M‐H, Fixed, 95% CI)

4.41 [1.23, 15.77]

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Comparison 2. Combined low dose OCP versus Combined low doseOCP