Comparison of Effectiveness in Endometriosis Treatment and Patient Acceptability between Intramuscular Depot-Medroxyprogesterone Acetate and Oral Desogestrel

Main Article Content

Pichavit Boonnum
Worashorn Lattiwongsakorn
Tawiwan Pantasri
Opas Sreshthaputra


Objectives: To compare the effectiveness in the initial treatment of endometriosis and patient acceptability between intramuscular depot-medroxy progesterone acetate (DMPA) and oral desogestrel (DSG).
Materials and Methods: A comparative study based on patient preference was conducted on women aged 18-45 years who first presented with endometriosis-like symptoms, between July 2018 and February 2019 at Maharaj Nakorn Chiang Mai Hospital. The participants were assigned to either a DMPA or DSG group based on their preference, after being informed. The primary outcome was the effectiveness of treatment for 12 weeks, measuring by visual analog score (VAS) of dysmenorrhea, dyspareunia, and chronic pelvic pain. The secondary outcome was patient acceptability in terms of level of satisfaction with the medication, quality of life, side effects, and rate of continuation.
Results: Sixty-one patients, 39 in DMPA group and 22 in DSG group, were enrolled into the study. After treatment, the median VAS score for dysmenorrhea was significantly decreased in each group (DMPA: 7.61 to 2.92, p < 0.001; DSG: 7.81 to 2.86, p < 0.001) but the reduction score was not significantly different between the two groups. The quality of life (EuroQol group-5Dimensions-5Levels or EQ-5D-5L) also significantly improved in both groups. Breakthrough bleeding was the most common side effect and the highest level of concern. Satisfaction and rate of continuation were not significantly different between the two groups. The acceptability rate was not significantly different.
Conclusion: After 12 weeks of treatment, the effectiveness in treatment and patient acceptability in the DMPA and DSG group were comparable.


Download data is not yet available.

Article Details

Original Article


1. ACOG Practice Bulletin No. 114: Management of Endometriosis. Obstet Gynecol 2010;116:223-36.
2. Fotherby K, Howard G. Return of fertility in women discontinuing injectable contraceptives. J Obstet Gynaecol 1986;6 Suppl 2:S110-5.
3. Barra F, Scala C, Ferrero S. Current understanding on pharmacokinetics, clinical efficacy and safety of progestins for treating pain associated to endometriosis. Expert Opin Drug Metab Toxicol 2018;14:399-415.
4. Crosignani PG, Luciano A, Ray A, Bergqvist A. Subcutaneous depot medroxyprogesterone acetate versus leuprolide acetate in the treatment of endometriosis-associated pain. Hum Reprod 2006; 21:248-56.
5. Faculty of Family Planning & Reproductive Health Care, Clinical Effectiveness Unit. Desogestrel-only pill (Cerazette). J Fam Plann Reprod Health Care 2003;29:162-4.
6. Korver T. A double-blind study comparing the contraceptive efficacy, acceptability and safety of two progestogen-only pills containing desogestrel 75 μg/day or levonorgestrel 30 μg/day: Collaborative Study Group on the Desogestrel-containing Progestogen-only Pill. Eur J Contracept Reprod Health Care 2009;3:169-78.
7. Razzi S, Luisi S, Ferretti C, Calonaci F, Gabbanini M, Mazzini M, et al. Use of a progestogen only preparation containing desogestrel in the treatment of recurrent pelvic pain after conservative surgery for endometriosis. Eur J Obstet Gynecol Reprod Biol 2007;135:188-90.
8. Tanmahasamut P, Saejong R, Rattanachaiyanont M, Angsuwathana S, Techatraisak K, Sanga-Areekul N. Postoperative desogestrel for pelvic endometriosis-related pain: a randomized controlled trial. Gynecol Endocrinol 2017;33:534-9.
9. Pardthaisong T, Gray RH, McDaniel EB. Return of fertility after discontinuation of depot medroxyprogesterone acetate and intra-uterine devices in Northern Thailand. Lancet 1980;1:509-12.
10. Hassan MAM, Killick SR. Is previous use of hormonal contraception associated with a detrimental effect on subsequent fecundity? Hum Reprod 2004;19:344-51.
11. Nisenblat V, Prentice L, Bossuyt PM, Farquhar C, Hull ML, Johnson N. Combination of the non-invasive tests for the diagnosis of endometriosis. Cochrane Database Syst Rev 2016;7:CD012281.
12. Royal College of Obstetricians and Gynaecologists. The initial management of chronic pelvic pain. Green-top Guideline No.41 RCOG 2012.
13. ACOG practice bulletin. No. 73: Use of hormonal contraception in women with coexisting medical conditions. Obstet Gynecol 2006;107:1453-72.
14. Curtis KM, Jatlaoui TC, Tepper NK, Zapata LB, Horton LG, Jamieson DJ, et al. U.S. Selected Practice Recommendations for Contraceptive Use, 2016. MMWR Recomm Rep 2016;65:1-66.
15. Horvath S SC, Sonalkar S. Contraindications to Progestin-only Hormonal Contraceptives. Endotext [Internet].2000 [cited 2019 Dec 29].Available from:
16. Ballantyne JC, Kalso E, Stannard C. WHO analgesic ladder: a good concept gone astray. BMJ 2016;352:i20.
17. Touboul C, Amate P, Ballester M, Bazot M, Fauconnier A, Daraï E. Quality of life assessment using EuroQOL EQ-5D questionnaire in patients with deep infiltrating endometriosis: The relation with symptoms and locations. Int J Chronic Dis 2013;2013:452134.
18. Aubry G, Panel P, Thiollier G, Huchon C, Fauconnier A. Measuring health-related quality of life in women with endometriosis: comparing the clinimetric properties of the Endometriosis Health Profile-5 (EHP-5) and the EuroQol-5D (EQ-5D). Hum Reprod 2017;32:1258-69.
19. Kaplan B. Desogestrel, norgestimate, and gestodene: the newer progestins. Ann Pharmacother 1995;29:736-42.
20. Leelaphiwat S, Jongwutiwes T, Lertvikool S, Tabcharoen C, Sukprasert M, Rattanasiri S, et al. Comparison of desogestrel/ethinyl estradiol plus spironolactone versus cyproterone acetate/ethinyl estradiol in the treatment of polycystic ovary syndrome: a randomized controlled trial. J Obstet Gynaecol Res 2015;41:402-10.
21. Walch K, Unfried G, Huber J, Kurz C, van Trotsenburg M, Pernicka E, et al. Implanon versus medroxyprogesterone acetate: effects on pain scores in patients with symptomatic endometriosis--a pilot study. Contraception 2009;79:29-34.
22. Grandi G, Barra F, Ferrero S, Sileo FG, Bertucci E, Napolitano A, et al. Hormonal contraception in women with endometriosis: a systematic review. Eur J Contracept Reprod Health Care 2019;24:61-70.
23. Casper RF. Progestin-only pills may be a better first-line treatment for endometriosis than combined estrogen-progestin contraceptive pills. Fertil Steril 2017;107:533-6.
24. Korver T KC, Heger-Mahn D, Duijkers I, van Osta G, Dieben T. Maintenance of ovulation inhibition with the 75 microg desogestrel-only contraceptive pill (Cerazette) after scheduled 12-h delays in tablet intake. Contraception 2005;71:8-13.
25. Clark MK, Sowers M, Levy B, Nichols S. Bone mineral density loss and recovery during 48 months in first-time users of depot medroxyprogesterone acetate. Fertil Steril 2006;86:1466-74.
26. Berenson AB, Breitkopf CR, Grady JJ, Rickert VI, Thomas A. Effects of hormonal contraception on bone mineral density after 24 months of use. Obstet Gynecol 2004;103:899-906.
27. McCann MF, Potter LS. Progestin-only oral contraception: a comprehensive review. Contraception 1994;50(6 Suppl 1):S1-195.
28. Vercellini P, De Giorgi O, Oldani S, Cortesi I, Panazza S, Crosignani PG. Depot medroxyprogesterone acetate versus an oral contraceptive combined with very-low-dose danazol for long-term treatment of pelvic pain associated with endometriosis. Am J Obstet Gynecol 1996;175:396-401.
29. Lopez LM, Ramesh S, Chen M, Edelman A, Otterness C, Trussell J, et al. Progestin-only contraceptives: effects on weight. Cochrane Database Syst Rev 2016:CD008815.