Add-on effect of curcumin to dienogest in patients with endometriosis: a randomized, double-blind, controlled trial

Background: Endometriosis is a chronic gynecological disorder characterized by significant pain and reduced quality of life (QOL). Current treatments, such as dienogest, are not fully effective, prompting the investigation of curcumin as a potential adjunct therapy. Although curcumin has demonstrated promise in preclinical studies, its clinical efficacy in endometriosis, particularly in combination with standard therapies like dienogest, remains underexplored. Purpose: This is the first study aimed to evaluate the add-on effect of curcumin in combination with dienogest on pain relief, QOL, and sexual function in women with endometriosis. Study design: A randomized, double-blind, placebo-controlled trial was conducted to compare the efficacy of curcumin combined with dienogest versus dienogest alone with a placebo. Methods: Eighty-six women aged 18-45 with stage 2-3 pelvic endometriosis and moderate to severe pain (visual analogue scale (VAS) >= 4) were randomly assigned in a 1:1 ratio to receive either nanocurcumin soft gel capsules (80 mg/day) or a placebo, along with dienogest (2 mg/day), for 8 weeks. Outcomes were assessed using adjusted mean differences (aMD) and 95 % confidence intervals (CIs). Results: After 8 weeks, the curcumin and dienogest group demonstrated significantly greater improvements in pain scores compared to the placebo group: dysmenorrhea (aMD: -1.55, 95 %CI: -2.04 to -1.06; p < 0.001), dyspareunia (aMD: -0.93, 95 %CI: -1.37 to -0.49; p < 0.001), chronic pelvic pain (aMD: -1.55, 95 %CI: -2.04 to -1.06; p < 0.001), and dyschezia (aMD: -0.30, 95 %CI: -0.58 to -0.03; p = 0.030). Additional benefits were observed in QOL and Female Sexual Function Index (FSFI) scores, except for the orgasm domain. Differences in endometrioma size were not statistically significant. Conclusion: The combination of curcumin and dienogest significantly reduced pain and improved QOL and sexual function in women with endometriosis, suggesting curcumin as an effective adjunct therapy.