title: Comparison of combined hormonal vaginal ring and low dose combined oral hormonal pill for the treatment of idiopathic chronic pelvic pain: a randomised trial.
abstract: OBJECTIVE
  To compare the efficacy and acceptability of combined hormonal vaginal ring with combined oral hormonal pill in women with idiopathic chronic pelvic pain.
  
  
  METHODS
  Randomised prospective interventional trial conducted in 60 women with idiopathic chronic pelvic pain. Women were randomised into two groups of 30 each. In each group, treatment was given for 84 days using either combined vaginal ring or combined oral hormonal pill. Hormonal vaginal ring releases 15mcg of ethinyl estradiol and 120mcg of the etonogestrel per day while the hormonal pill contained 30mcg of ethinyl estradiol and 150mcg of levonorgestrel. There was no ring or pill free week. After every 28 days, pain relief was measured using visual analogue scale (VAS), and verbal rating score (VRS) calculated by summing dysmenorrhea, non-cyclic pelvic pain (NCCP) and deep dyspareunia scores. Side effects, compliance, satisfaction, and user acceptability were also measured. Data was analyzed using various parametric and non-parametric tests.
  
  
  RESULTS
  Reduction in mean VAS score at end of treatment in ring group was 6.23 (95% confidence interval [CI], 5.45-7.01; p<0.001) as compared to 5.53 in pill group (95% CI, 4.83-6.23; p<0.001). Reduction in mean VRS score was 5.63 in ring users (95% CI, 4.84-6.42; p<0.001) versus 4.36 in pill users (95% CI, 3.63-5.10; p<0.001). A significantly higher persistent relief in NCPP score was observed in vaginal ring group as compared to oral pill group at end of one month after stopping treatment. Compliance, satisfaction, and user acceptability were higher in ring users (80%) than pill users (70%) and a higher incidence of nausea was seen in pill group.
  
  
  CONCLUSIONS
  Present study demonstrates for first time that both vaginal and oral hormonal therapy are effective in treatment of idiopathic chronic pelvic pain and vaginal ring may be a better choice with higher satisfaction rate and fewer side effects.
authors.affiliation: Department Of Obstetrics & Gynecology, UCMS & GTB Hospital, New Delhi, India. Electronic address: khushbu.priya87@gmail.com.
authors.forename: Khushboo
authors.initials: K
authors.lastname: Priya
authors.affiliation: Department Of Obstetrics & Gynecology, UCMS & GTB Hospital, New Delhi, India.
authors.forename: Shalini
authors.initials: S
authors.lastname: Rajaram
authors.affiliation: Department Of Obstetrics & Gynecology, UCMS & GTB Hospital, New Delhi, India.
authors.forename: Neerja
authors.initials: N
authors.lastname: Goel
mesh_terms: D000293:Adolescent; D000328:Adult; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000453:epidemiology / Q000208:ethnology; D059350:Chronic Pain / Q000097:blood / Q000188:drug therapy* / Q000208:ethnology; D003274:Contraceptive Devices, Female / Q000009:adverse effects; D003277:Contraceptives, Oral, Combined / Q000009:adverse effects / Q000627:therapeutic use*; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003692:Delayed-Action Preparations / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D017135:Desogestrel / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D004997:Ethinyl Estradiol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India / Q000453:epidemiology; D016912:Levonorgestrel / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D055118:Medication Adherence / Q000208:ethnology; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced / Q000453:epidemiology; D017060:Patient Satisfaction / Q000208:ethnology; D017699:Pelvic Pain / Q000097:blood / Q000188:drug therapy* / Q000208:ethnology; D012306:Risk; D055815:Young Adult
chemical_list: D003277:Contraceptives, Oral, Combined; D003278:Contraceptives, Oral, Hormonal; D003692:Delayed-Action Preparations; C044815:etonogestrel; D004997:Ethinyl Estradiol; D016912:Levonorgestrel; D017135:Desogestrel
keywords: Chronic pelvic pain; Endometriosis; Hormonal vaginal ring; Oral hormonal pill