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Efficacy of ethinylestradiol 20 µg/drospirenone 3 mg in a flexible extended regimen in women with moderate-to-severe primary dysmenorrhoea: an open-label, multicentre, randomised, controlled study
  1. Thomas Strowitzki1,
  2. Bodo Kirsch2,
  3. Jörg Elliesen3
  1. 1Medical Director, Department of Gynecological Endocrinology and Reproductive Medicine, University of Heidelberg, Heidelberg, Germany
  2. 2Project Statistician, Bayer HealthCare Pharmaceuticals, Berlin, Germany
  3. 3Global Clinical Leader, Bayer HealthCare Pharmaceuticals, Berlin, Germany
  1. Correspondence to Dr Jörg Elliesen, Bayer HealthCare Pharmaceuticals, Müllerstrasse 178, D-13353 Berlin, Germany; joerg.elliesen{at}


Objectives The aim of this Phase III, multicentre, open-label, randomised study was to compare the efficacy and safety of ethinylestradiol (EE)/drospirenone (DRSP) in a new flexible extended regimen that allowed the management of intracyclic (breakthrough) bleeding (MIB) with that of EE/DRSP in a conventional 28-day regimen in women with moderate-to-severe primary dysmenorrhoea.

Methods Women (aged 18–40 years) with moderate-to-severe primary dysmenorrhoea-related pain received a flexible extended regimen with MIB (flexibleMIB; minimum 24, maximum 120 days of continuous tablet intake for a flexible number of cycles to reach a treatment duration of at least 140 days with 4-day breaks between cycles) or a conventional 28-day regimen (24 active and four placebo tablets for five cycles) of EE/DRSP. The primary outcome was the number of days with dysmenorrhoeic pain over 140 days. Secondary outcomes included other dysmenorrhoea-related pain outcomes, bleeding profile, satisfaction and safety.

Results Overall, 223 patients received study medication. There were significantly fewer days with dysmenorrhoeic pain with the flexibleMIB regimen than the conventional regimen (difference −4.2 days, 95% CI −6.5 to −2.0; p=0.0003), as well as considerably fewer days with at least moderate dysmenorrhoeic pain (difference −2.5 days, 95% CI −3.7 to −1.3), dysmenorrhoeic pain that interfered with daily activities (difference −2.2 days, 95% CI −4.2 to −0.1) and pelvic pain (difference −3.4 days, 95% CI −5.9 to −0.9). Adverse events were similar with both regimens.

Conclusions Compared with the conventional regimen, the flexible extended regimen of EE/DRSP with MIB was associated with a significantly greater reduction in days with dysmenorrhoeic pain in women with moderate-to-severe primary dysmenorrhoea. The flexibleMIB regimen was also associated with greater improvements in dysmenorrhea according to the Clinical Global Impression rating scale and was generally well tolerated.

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  • Funding This study was funded by Bayer HealthCare Pharmaceuticals, Berlin, Germany, the manufacturer of ethinylestradiol 20 µg/drospirenone 3 mg.

  • Competing interests Thomas Strowitzki has acted as a speaker for Bayer HealthCare Pharmaceuticals at various symposia and congresses. Bodo Kirsch and Jörg Elliesen are employees of Bayer HealthCare Pharmaceuticals.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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