To Compare SH T00658ID Over Ortho Tri-Cyclen Lo (US/Canada)

A Multicenter, Randomized, Double-blind, Active-controlled, Parallel Group, 2-arm Study to Show Superiority of the Oral Contraceptive SH T00658ID Over Ortho Tri-Cyclen Lo on Hormone Withdrawal-associated Symptoms After 6 Cycles of Treatment.

Status

Completed

Phases

Phase 3

Study type

Interventional

Source

ClinicalTrials.gov

Registry ID

NCT00754065

Enrollment

409

Registered

2008-09-17

Start date

2008-09-08

Completion date

2011-05-10

Last updated

2024-11-20

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Contraception

Keywords

Oral contraceptive, Estradiol valerate and dienogest, EV/DNG, comparative tolerability

Brief summary

The objective of the study is to compare the oral contraceptive (OC) SH T00658ID over Ortho Tri-Cyclen Lo administered for 13 cycles to healthy female volunteers between 18 and 50 years of age who request oral contraceptive protection. Subjects on a levonorgestrel (LNG), norgestimate (NGM), norethindrone or norethindrone acetate containing oral contraceptive in a 21-day regimen suffering from hormone withdrawal-associated symptoms such as pelvic pain or headache or both, and willing to continue OC use but to switch to SH T00658ID or Ortho Tri-Cyclen Lo.

Detailed description

Safety issues are addressed in the Adverse Events section.

Interventions

DRUGEstradiol valerate, Dienogest (Natazia, Qlaira, BAY86-5027)

Estradiol valerate (EV) and dienogest (DNG). Sequential 4-phasic regimen. Daily oral administration of one encapsulated BAY86-5027 for 28 days per Cycle, for 13 treatment cycles: Days 1-2, 3.0 mg EV; Days 3-7, 2.0 mg EV+2.0 mg DNG; Days 8-24, 2.0 mg EV+3.0 mg DNG; Days 25-26, 1.0 mg EV; Days 27-28, placebo

DRUGOrtho Tri Cyclen Lo

Dose--Ethinylestradiol (EE) + Norgestimate (NGM) Triphasic 21-day regimen. Daily oral administration of one encapsulated Ortho Tri-Cyclen Lo for 28 days per Cycle, for 13 treatment cycles: Days 1-7, 0.025 mg EE+0.180 NGM; Days 8-14, 0.025 mg EE+0.215 NGM; Days 15-21, 0.025 mg EE+0.250 NGM; Days 27-28, placebo

Study design

Allocation

RANDOMIZED

Intervention model

PARALLEL

Primary purpose

TREATMENT

Masking

DOUBLE (Subject, Investigator)

Eligibility

Sex/Gender

FEMALE

Age

18 Years to 50 Years

Healthy volunteers

Yes

Inclusion criteria

* Signed and dated informed consent * Age between 18 and 50 years (inclusive), smokers maximum age of 35 years (inclusive) at Visit 1 * Otherwise healthy female subjects requesting contraception and currently using a LNG, NGM, or norethindrone/norethindrone acetate containing OC in a 21-day regimen and suffering from at least moderate pelvic pain, headache or both defined by an average of the highest 3 values of \>/=35 mm on a VAS during cycle days 22-28 (35 mm VAS is the expected standard deviation of the population VAS reduction) * Normal or clinically insignificant cervical smear not requiring further follow up (a cervical smear has to be taken at screening visit or a normal result has to be documented within the last 6 months before screening) Women with atypical squamous cell of undetermined significance (ASCUS) can be included if they have a negative human papilloma virus (HPV) test result. The laboratory will perform an HPV test if the Pap smear result is ASCUS. * Able to tolerate ibuprofen and willing to use only ibuprofen supplied by the investigator

Exclusion criteria

* Pregnancy or lactation (less than three cycles since delivery, abortion, or lactation before start of treatment) * Body mass index (BMI) \>32 kg/m2 * Hypersensitivity to any of the study drug ingredients * Individuals not willing to consume pork and beef products. Women may be included if they are willing to take the capsules * Safety relevant laboratory values, provided by the central laboratory, outside inclusion range before start of treatment * Any diseases or conditions that can compromise the function of the body systems and could result in altered absorption, excessive accumulation, impaired metabolism, or altered excretion of the study medication (such as but not limited to duodenal ulcers, gastritis, gastrectomy or gastric resection surgery, or renal compromise) * Any diseases or conditions that might interfere with the conduct of the study or the interpretation of the results * Any disease or condition that may worsen under hormonal treatment * Undiagnosed abnormal genital bleeding * Abuse of alcohol, drugs, or medicines (eg, laxatives) * Other contraceptive methods * Any medication that could result in excessive accumulation, impaired metabolism, or altered excretion of the study drug or interfere with the conduct of the study or the interpretation of the results * Simultaneous participation in another clinical trial prior to study entry that might have an impact on the study objectives at the discretion of the investigator * Major surgery scheduled for the study period * Subject is a dependent person, eg: a family member or member of the Investigator's staff * Inability to cooperate with the study procedures for any reason, including language comprehension, psychiatric illness, inability to get to the study site

Design outcomes

Primary

Measure	Time frame	Description
The Change in Average of the 3 Highest Visual Analog Scale (VAS) Values of the Hormone Withdrawal-associated Symptoms Pelvic Pain or Headache During Cycle Days 22 to 28 From Baseline to Cycle 6	Day 22-28 from Baseline to Day 22-28 from Cycle 6 (28 days per Cycle)	Subject self-assessed pelvic pain or headache per visual analog scale (VAS) values during the menstrual/withdrawal bleeding episode and Baseline. The VAS consists of a 100 mm long straight line, with verbal anchors at either end, representing a continuum of pain intensity. Accordingly, the scale ranges from 0 mm (absence of pain) to 100 mm (unbearable pain), and the change ranges from -100 mm (best) to 100 mm (worst).

Secondary

Measure	Time frame	Description
The Change From Baseline to Cycle 6 in the Number of Ibuprofen Tablets Used as Rescue Medication	From Baseline to Cycle 6 (28 days per Cycle)	Rescue medication use was standardized intake of 200 mg Ibuprofen tablets. Baseline period: 7 days (Day 22) before the first menstrual bleeding until Day 28 (normalized to a standard 28-day cycle). Treatment period: 7 days (Day 22) before the withdrawal bleeding (WB) of the 6th treatment cycle until Day 28 of the same cycle (normalized to a standard 28-day cycle). Number of tablets taken by each subject, and then the Mean and standard deviation (SD) derived.
The Change From Baseline to Cycle 13 in the Number of Ibuprofen Tablets Used as Rescue Medication	From Baseline to Cycle 13 (28 days per Cycle)	Rescue medication use was standardized intake of 200 mg Ibuprofen tablets. Baseline period: 7 days (Day 22) before the first menstrual bleeding until Day 28 (normalized to a standard 28-day cycle). Treatment period: 7 days (Day 22) before the withdrawal bleeding (WB) of the 13th treatment cycle until Day 28 before the same cycle (normalized to a standard 28-day cycle). Number of tablets taken by each subject, and then the Mean and standard deviation ((SD) derived.
Change From Baseline to Cycle 6 in the Number of Days With at Least Moderate Pain/Intensity of Other Hormone-related Symptoms During Cycle Days 22-28	Day 22-28 from Baseline to Day 22-28 from Cycle 6 (28 days per Cycle)	Pain (pelvic, headache, bloating or swelling, breast tenderness, nausea or vomiting) during menstrual/withdrawal bleeding (WB) episode during cycle Days 22-28. Scores per day: 0 No pain; 1 Mild pain with no need for painkiller; 2 Moderate pain with need for painkiller; 3 Severe pain with need for painkiller. Baseline period: cycle Days 22-28 before 1st menstrual bleeding (normalized to a 7-day period). Treatment period: cycle Days 22-28 before WB of 6th treatment cycle until (normalized to a 7-day period). Score difference min -7 (best), max 7 (worst).
Change From Baseline to Cycle 13 in the Number of Days With at Least Moderate Pain/Intensity of Other Hormone-related Symptoms During Cycle Days 22-28	Day 22-28 from Baseline to Day 22-28 from Cycle 13 (28 days per Cycle)	Pain (pelvic, headache, bloating or swelling, breast tenderness, nausea or vomiting) during menstrual/withdrawal bleeding (WB) episode during cycle Days 22-28. Scores per day: 0 No pain; 1 Mild pain with no need for painkiller; 2 Moderate pain with need for painkiller; 3 Severe pain with need for painkiller. Baseline period: cycle Days 22-28 before 1st menstrual bleeding (normalized to a 7-day period). Treatment period: cycle Days 22-28 before WB of 13th treatment cycle (normalized to a 7-day period). Score difference min -7 (best), max 7 (worst).
Change From Baseline to Cycle 6 in the Number of Days With at Least Moderate Pain/Intensity of Individual Hormone-related Symptoms During Cycle Days 1-21	Day 1-21 from Baseline to Day 1-21 from Cycle 6 (28 days per Cycle)	Pain (pelvic, headache, bloating or swelling, breast tenderness, nausea or vomiting) during menstrual/withdrawal bleeding (WB) episode during cycle Days 1-21. Scores per day: 0 No pain; 1 Mild pain with no need for painkiller; 2 Moderate pain with need for painkiller; 3 Severe pain with need for painkiller. Baseline period: cycle Days 1-21 before 1st menstrual bleeding (normalized to a 21-day period). Treatment period: cycle Days 1-21 before WB of 6th treatment cycle (normalized to a 21-day period). Score difference min -21 (best), max 21 (worst).
Change From Baseline to Cycle 13 in the Number of Days With at Least Moderate Pain/Intensity of Individual Hormone-related Symptoms During Cycle Days 1-21	Day 1-21 from Baseline to Day 1-21 from Cycle 13 (28 days per Cycle)	Pain (pelvic, headache, bloating or swelling, breast tenderness, nausea or vomiting) during menstrual/withdrawal bleeding (WB) episode during cycle Days 1-21. Scores per day: 0 No pain; 1 Mild pain with no need for painkiller; 2 Moderate pain with need for painkiller; 3 Severe pain with need for painkiller. Baseline period: cycle Days 1-21 before 1st menstrual bleeding (normalized to a 21-day period). Treatment period: cycle Days 1-21 before WB of 13th treatment cycle (normalized to a 21-day period). Score difference min -21 (best), max 21 (worst).
Change From Baseline to Cycle 6 in the Number of Days With at Least Moderate Pain/Intensity of Individual Hormone-related Symptoms During the Hormone-free Interval Cycle Days 27 to 28 for EV/DNG and Cycle Days 22 to 28 for EE/NGM	From Baseline to Cycle 6 (cycle Days 27 to 28 for EV/DNG and cycle Days 22 to 28 for EE/NGM, 28 days per Cycle)	Pain (pelvic, headache, bloating or swelling, breast tenderness, nausea or vomiting) during menstrual/withdrawal bleeding (WB) episode (cycle Days 22-28). Scores per day: 0 No pain; 1 Mild pain with no need for painkiller; 2 Moderate pain with need for painkiller; 3 Severe pain with need for painkiller. Score difference min -2 (best), max 2 (worst) for the estradiol valerate (EV)/dienogest (DNG) group and min -7 (best), max 7 (worst) for the ethinylestradiol (EE)/norgestimate (NGM) group.
Change From Baseline to Cycle 13 in the Number of Days With at Least Moderate Pain/Intensity of Individual Hormone-related Symptoms During the Hormone-free Interval Cycle Days 27 to 28 for EV/DNG and Cycle Days 22 to 28 for EE/NGM	From Baseline to Cycle 13 (cycle Days 27 to 28 for EV/DNG and cycle Days 22 to 28 for EE/NGM, 28 days per Cycle)	Pain (pelvic, headache, bloating or swelling, breast tenderness, nausea or vomiting) during menstrual/withdrawal bleeding (WB) episode (cycle Days 22-28). Scores per day: 0 No pain; 1 Mild pain with no need for painkiller; 2 Moderate pain with need for painkiller; 3 Severe pain with need for painkiller. Score difference min -2 (best), max 2 (worst) for the EV/DNG group and min -7 (best), max 7 (worst) for the EE/NGM group.
Change From Baseline to Cycle 3 in the Average of the Three Highest VAS Values of the Hormone Withdrawal-associated Symptoms Pelvic Pain or Headache During Cycle Days 22 to 28	Days 22-28 from Baseline to Days 22-28 from Cycle 3 (28 days per Cycle)	Subject self-assessed pelvic pain or headache per visual analog scale (VAS) values during the menstrual/withdrawal bleeding episode and Baseline. The VAS consists of a 100 mm long straight line, with verbal anchors at either end, representing a continuum of pain intensity. Accordingly, the scale ranges from 0 mm (absence of pain) to 100 mm (unbearable pain), and the change ranges from -100 mm (best) to 100 mm (worst).
Change From Baseline to Cycle 13 in the Average of the Three Highest VAS Values of the Hormone Withdrawal-associated Symptoms Pelvic Pain or Headache During Cycle Days 22 to 28	Days 22-28 from Baseline to Days 22-28 from Cycle 13 (28 days per Cycle)	Subject self-assessed pelvic pain or headache per visual analog scale (VAS) values during the menstrual/withdrawal bleeding episode and Baseline. The VAS consists of a 100 mm long straight line, with verbal anchors at either end, representing a continuum of pain intensity. Accordingly, the scale ranges from 0 mm (absence of pain) to 100 mm (unbearable pain), and the change ranges from -100 mm (best) to 100 mm (worst).
Number of Days With Bleeding or Spotting in Reference Period 1	From Day 1 to Day 90	Reference Period 1 is defined as Day 1 to Day 90 during study treatment and includes the initial bleeding episode that triggered the first intake of study medication, meaning that the first treatment cycle includes 2 bleeding episodes.
Number of Days With Bleeding or Spotting in Reference Period 2	From Day 91 to Day 180	Reference Period 2 is defined as Day 91 to Day 180 during study treatment.
Number of Days With Bleeding or Spotting in Reference Period 3	From Day 181 to Day 270	Reference Period 3 is defined as Day 181 to Day 270 during study treatment.
Number of Days With Bleeding or Spotting in Reference Period 4	From Day 271 to Day 360	Reference Period 4 is defined as Day 271 to Day 360 during study treatment.
Number of Bleeding / Spotting Episodes in Reference Period 1	From Day 1 to Day 90	Reference Period 1 is defined as Day 1 to Day 90 during study treatment and includes the initial bleeding episode that triggered the first intake of study medication, meaning that the first treatment cycle includes 2 bleeding episodes. (Episode is a set of days with bleeding/spotting)
Number of Bleeding / Spotting Episodes in Reference Period 2	From Day 91 to Day 180	Reference Period 2 is defined as Day 91 to Day 180 during study treatment. (Episode is a set of days with bleeding/spotting)
Number of Bleeding / Spotting Episodes in Reference Period 3	From Day 181 to Day 270	Reference Period 3 is defined as Day 181 to Day 270 during study treatment. (Episode is a set of days with bleeding/spotting)
Number of Bleeding / Spotting Episodes in Reference Period 4	From Day 271 to Day 360	Reference Period 4 is defined as Day 271 to Day 360 during study treatment. (Episode is a set of days with bleeding/spotting)
Mean Length of Bleeding / Spotting Episodes in Reference Period 1	From Day 1 to Day 90	Reference Period 1 is defined as Day 1 to Day 90 during study treatment and includes the initial bleeding episode that triggered the first intake of study medication, meaning that the first treatment cycle includes 2 bleeding episodes.
Mean Length of Bleeding / Spotting Episodes in Reference Period 2	From Day 91 to Day 180	Reference Period 2 is defined as Day 91 to Day 180 during study treatment.
Mean Length of Bleeding / Spotting Episodes in Reference Period 3	From Day 181 to Day 270	Reference Period 3 is defined as Day 181 to Day 270 during study treatment.
Mean Length of Bleeding / Spotting Episodes in Reference Period 4	From Day 271 to Day 360	Reference Period 4 is defined as Day 271 to Day 360 during study treatment.
Maximum Length of Bleeding / Spotting Episodes in Reference Period 1	From Day 1 to Day 90	Reference Period 1 is defined as Day 1 to Day 90 during study treatment and includes the initial bleeding episode that triggered the first intake of study medication, meaning that the first treatment cycle includes 2 bleeding episodes.
Maximum Length of Bleeding / Spotting Episodes in Reference Period 2	From Day 91 to Day 180	Reference Period 2 is defined as Day 91 to Day 180 during study treatment.
Maximum Length of Bleeding / Spotting Episodes in Reference Period 3	From Day 181 to Day 270	Reference Period 3 is defined as Day 181 to Day 270 during study treatment.
Maximum Length of Bleeding / Spotting Episodes in Reference Period 4	From Day 271 to Day 360	Reference Period 4 is defined as Day 271 to Day 360 during study treatment.
Difference in Duration Between Longest and Shortest Bleeding / Spotting Episodes in Reference Period 1	From Day 1 to Day 90	Reference Period 1 is defined as Day 1 to Day 90 during study treatment and includes the initial bleeding episode that triggered the first intake of study medication, meaning that the first treatment cycle includes 2 bleeding episodes.
Difference in Duration Between Longest and Shortest Bleeding / Spotting Episodes in Reference Period 2	From Day 91 to Day 180	Reference Period 2 is defined as Day 91 to Day 180 during study treatment.
Difference in Duration Between Longest and Shortest Bleeding / Spotting Episodes in Reference Period 3	From Day 181 to Day 270	Reference Period 3 is defined as Day 181 to Day 270 during study treatment.
Difference in Duration Between Longest and Shortest Bleeding / Spotting Episodes in Reference Period 4	From Day 271 to Day 360	Reference Period 4 is defined as Day 271 to Day 360 during study treatment.
Number of Days With Spotting-only in Reference Period 1	From Day 1 to Day 90	Reference Period 1 is defined as Day 1 to Day 90 during study treatment.
Number of Days With Spotting-only in Reference Period 2	From Day 91 to Day 180	Reference Period 2 is defined as Day 91 to Day 180 during study treatment.
Number of Days With Spotting-only in Reference Period 3	From Day 181 to Day 270	Reference Period 3 is defined as Day 181 to Day 270 during study treatment.
Number of Days With Spotting-only in Reference Period 4	From Day 271 to Day 360	Reference Period 4 is defined as Day 271 to Day 360 during study treatment.
Number of Spotting-only Episodes in Reference Period 1	From Day 1 to Day 90	Reference Period 1 is defined as Day 1 to Day 90 during study treatment.
Number of Spotting-only Episodes in Reference Period 2	From Day 91 to Day 180	Reference Period 2 is defined as Day 91 to Day 180 during study treatment.
Number of Spotting-only Episodes in Reference Period 3	From Day 181 to Day 270	Reference Period 3 is defined as Day 181 to Day 270 during study treatment.
Number of Spotting-only Episodes in Reference Period 4	From Day 271 to Day 360	Reference Period 4 is defined as Day 271 to Day 360 during study treatment.
Mean Length of Spotting-only Episodes in Reference Period 1	From Day 1 to Day 90	Reference Period 1 is defined as Day 1 to Day 90 during study treatment.
Mean Length of Spotting-only Episodes in Reference Period 2	From Day 91 to Day 180	Reference Period 2 is defined as Day 91 to Day 180 during study treatment.
Mean Length of Spotting-only Episodes in Reference Period 3	From Day 181 to Day 270	Reference Period 3 is defined as Day 181 to Day 270 during study treatment.
Mean Length of Spotting-only Episodes in Reference Period 4	From Day 271 to Day 360	Reference Period 4 is defined as Day 271 to Day 360 during study treatment.
Maximum Length of Spotting-only Episodes in Reference Period 1	From Day 1 to Day 90	Reference Period 1 is defined as Day 1 to Day 90 during study treatment.
Maximum Length of Spotting-only Episodes in Reference Period 2	From Day 91 to Day 180	Reference Period 2 is defined as Day 91 to Day 180 during study treatment.
Maximum Length of Spotting-only Episodes in Reference Period 3	From Day 181 to Day 270	Reference Period 3 is defined as Day 181 to Day 270 during study treatment.
Maximum Length of Spotting-only Episodes in Reference Period 4	From Day 271 to Day 360	Reference Period 4 is defined as Day 271 to Day 360 during study treatment.
Difference in Duration Between Longest and Shortest Spotting-only Episodes in Reference Period 1	From Day 1 to Day 90	Reference Period 1 is defined as Day 1 to Day 90 during study treatment and includes the initial bleeding episode that triggered the first intake of study medication, meaning that the first treatment cycle includes 2 bleeding episodes.
Difference in Duration Between Longest and Shortest Spotting-only Episodes in Reference Period 2	From Day 91 to Day 180	Reference Period 2 is defined as Day 91 to Day 180 during study treatment.
Difference in Duration Between Longest and Shortest Spotting-only Episodes in Reference Period 3	From Day 181 to Day 270	Reference Period 3 is defined as Day 181 to Day 270 during study treatment.
Difference in Duration Between Longest and Shortest Spotting-only Episodes in Reference Period 4	From Day 271 to Day 360	Reference Period 4 is defined as Day 271 to Day 360 during study treatment.
Percentage of Participants With / Without Withdrawal Bleeding at Cycle 1	At Cycle 1 (28 days per Cycle)	Withdrawal bleeding is bleeding that occurs when using oral contraceptives (OCs) caused by falling levels and/or taking away external source of estrogen and progestogen toward cycle end.
Percentage of Participants With / Without Withdrawal Bleeding at Cycle 3	At Cycle 3 (28 days per Cycle)	Withdrawal bleeding is bleeding that occurs when using oral contraceptives (OCs) caused by falling levels and/or taking away external source of estrogen and progestogen toward cycle end.
Percentage of Participants With / Without Withdrawal Bleeding at Cycle 6	At Cycle 6 (28 days per Cycle)	Withdrawal bleeding is bleeding that occurs when using oral contraceptives (OCs) caused by falling levels and/or taking away external source of estrogen and progestogen toward cycle end.
Percentage of Participants With / Without Withdrawal Bleeding at Cycle 13	At Cycle 13 (28 days per Cycle)	Withdrawal bleeding is bleeding that occurs when using oral contraceptives (OCs) caused by falling levels and/or taking away external source of estrogen and progestogen toward cycle end.
Length of Withdrawal Bleeding Episodes at Cycle 1	At Cycle 1 (28 days per Cycle)	Withdrawal bleeding is bleeding that occurs when using oral contraceptives (OCs) caused by falling levels and/or taking away external source of estrogen and progestogen toward cycle end.
Length of Withdrawal Bleeding Episodes at Cycle 3	At Cycle 3 (28 days per Cycle)	Withdrawal bleeding is bleeding that occurs when using oral contraceptives (OCs) caused by falling levels and/or taking away external source of estrogen and progestogen toward cycle end.
Length of Withdrawal Bleeding Episodes at Cycle 6	At Cycle 6 (28 days per Cycle)	Withdrawal bleeding is bleeding that occurs when using oral contraceptives (OCs) caused by falling levels and/or taking away external source of estrogen and progestogen toward cycle end.
Length of Withdrawal Bleeding Episodes at Cycle 13	At Cycle 13 (28 days per Cycle)	Withdrawal bleeding is bleeding that occurs when using oral contraceptives (OCs) caused by falling levels and/or taking away external source of estrogen and progestogen toward cycle end.
Maximum Intensity of Withdrawal Bleeding Episodes at Cycle 1	At Cycle 1 (28 days per Cycle)	Intensity was scored as 1=none, 2=spotting, 3=light, 4=normal, or 5=heavy.
Maximum Intensity of Withdrawal Bleeding Episodes at Cycle 3	At Cycle 3 (28 days per Cycle)	Intensity was scored as 1=none, 2=spotting, 3=light, 4=normal, or 5=heavy.
Maximum Intensity of Withdrawal Bleeding Episodes at Cycle 6	At Cycle 6 (28 days per Cycle)	Intensity was scored as 1=none, 2=spotting, 3=light, 4=normal, or 5=heavy.
Maximum Intensity of Withdrawal Bleeding Episodes at Cycle 13	At Cycle 13 (28 days per Cycle)	Intensity was scored as 1=none, 2=spotting, 3=light, 4=normal, or 5=heavy.
Onset of Withdrawal Bleeding Episodes at Cycle 1	At Cycle 1 (28 days per Cycle)	Onset was defined as the number of days between progestogen withdrawal and the first day of the withdrawal bleeding episode (ie, starting on or after Day 25 for EV/DNG and on or after Day 22 for EE/NGM).
Onset of Withdrawal Bleeding Episodes at Cycle 3	At Cycle 3 (28 days per Cycle)	Onset was defined as the number of days between progestogen withdrawal and the first day of the withdrawal bleeding episode (ie, starting on or after Day 25 for EV/DNG and on or after Day 22 for EE/NGM).
Onset of Withdrawal Bleeding Episodes at Cycle 6	At Cycle 6 (28 days per Cycle)	Onset was defined as the number of days between progestogen withdrawal and the first day of the withdrawal bleeding episode (ie, starting on or after Day 25 for EV/DNG and on or after Day 22 for EE/NGM).
Onset of Withdrawal Bleeding Episodes at Cycle 13	At Cycle 13 (28 days per Cycle)	Onset was defined as the number of days between progestogen withdrawal and the first day of the withdrawal bleeding episode (ie, starting on or after Day 25 for EV/DNG and on or after Day 22 for EE/NGM).
Percentage of Participants With Presence or Absence of Intracyclic Bleeding at Cycle 1	At Cycle 1 (28 days per Cycle)	Intracyclic bleeding is any unexpected bleeding episode occurring in cyclical treatment regimens.
Percentage of Participants With Presence or Absence of Intracyclic Bleeding at Cycle 3	At Cycle 3 (28 days per Cycle)	Intracyclic bleeding is any unexpected bleeding episode occurring in cyclical treatment regimens.
Percentage of Participants With Presence or Absence of Intracyclic Bleeding at Cycle 6	At Cycle 6 (28 days per Cycle)	Intracyclic bleeding is any unexpected bleeding episode occurring in cyclical treatment regimens.
Percentage of Participants With Presence or Absence of Intracyclic Bleeding at Cycle 13	At Cycle 13 (28 days per Cycle)	Intracyclic bleeding is any unexpected bleeding episode occurring in cyclical treatment regimens.
Number of Intracyclic Bleeding Episodes at Cycle 1	At Cycle 1 (28 days per Cycle)	Intracyclic bleeding is any unexpected bleeding episode occurring in cyclical treatment regimens. (Episode is a set of days with intracyclic bleeding)
Number of Intracyclic Bleeding Episodes at Cycle 3	At Cycle 3 (28 days per Cycle)	Intracyclic bleeding is any unexpected bleeding episode occurring in cyclical treatment regimens. (Episode is a set of days with intracyclic bleeding)
Number of Intracyclic Bleeding Episodes at Cycle 6	At Cycle 6 (28 days per Cycle)	Intracyclic bleeding is any unexpected bleeding episode occurring in cyclical treatment regimens. (Episode is a set of days with intracyclic bleeding)
Number of Intracyclic Bleeding Episodes at Cycle 13	At Cycle 13 (28 days per Cycle)	Intracyclic bleeding is any unexpected bleeding episode occurring in cyclical treatment regimens. (Episode is a set of days with intracyclic bleeding)
Maximum Length of Intracyclic Bleeding Episodes at Cycle 1	At Cycle 1 (28 days per Cycle)	Intracyclic bleeding is any unexpected bleeding episode occurring in cyclical treatment regimens.
Maximum Length of Intracyclic Bleeding Episodes at Cycle 3	At Cycle 3 (28 days per Cycle)	Intracyclic bleeding is any unexpected bleeding episode occurring in cyclical treatment regimens.
Maximum Length of Intracyclic Bleeding Episodes at Cycle 6	At Cycle 6 (28 days per Cycle)	Intracyclic bleeding is any unexpected bleeding episode occurring in cyclical treatment regimens.
Maximum Length of Intracyclic Bleeding Episodes at Cycle 13	At Cycle 13 (28 days per Cycle)	Intracyclic bleeding is any unexpected bleeding episode occurring in cyclical treatment regimens.
Number of Intracyclic Bleeding Days at Cycle 1	At Cycle 1 (28 days per Cycle)	Intracyclic bleeding is any unexpected bleeding episode occurring in cyclical treatment regimens.
Number of Intracyclic Bleeding Days at Cycle 3	At Cycle 3 (28 days per Cycle)	Intracyclic bleeding is any unexpected bleeding episode occurring in cyclical treatment regimens.
Number of Intracyclic Bleeding Days at Cycle 6	At Cycle 6 (28 days per Cycle)	Intracyclic bleeding is any unexpected bleeding episode occurring in cyclical treatment regimens.
Number of Intracyclic Bleeding Days at Cycle 13	At Cycle 13 (28 days per Cycle)	Intracyclic bleeding is any unexpected bleeding episode occurring in cyclical treatment regimens.
Percentage of Participants by Maximum Intensity of Intracyclic Bleeding Episodes at Cycle 1	At Cycle 1 (28 days per Cycle)	Intracyclic bleeding is any unexpected bleeding episode occurring in cyclical treatment regimens. Intensity was scored as 1=none, 2=spotting, 3=light, 4=normal, or 5=heavy.
Percentage of Participants by Maximum Intensity of Intracyclic Bleeding Episodes at Cycle 3	At Cycle 3 (28 days per Cycle)	Intracyclic bleeding is any unexpected bleeding episode occurring in cyclical treatment regimens. Intensity was scored as 1=none, 2=spotting, 3=light, 4=normal, or 5=heavy.
Percentage of Participants by Maximum Intensity of Intracyclic Bleeding Episodes at Cycle 6	At Cycle 6 (28 days per Cycle)	Intracyclic bleeding is any unexpected bleeding episode occurring in cyclical treatment regimens. Intensity was scored as 1=none, 2=spotting, 3=light, 4=normal, or 5=heavy.
Percentage of Participants by Maximum Intensity of Intracyclic Bleeding Episodes at Cycle 13	At Cycle 13 (28 days per Cycle)	Intracyclic bleeding is any unexpected bleeding episode occurring in cyclical treatment regimens. Intensity was scored as 1=none, 2=spotting, 3=light, 4=normal, or 5=heavy.
Percentage of Participants With at Least 1 Intracyclic Bleeding Episode at Cycles 2 to 6	Cycles 2 to 6 (28 days per Cycle)	Intracyclic bleeding is any unexpected bleeding episode occurring in cyclical treatment regimens.
Percentage of Participants With at Least 1 Intracyclic Bleeding Episode at Cycles 2 to 13	Cycles 2 to 13 (28 days per Cycle)	Intracyclic bleeding is any unexpected bleeding episode occurring in cyclical treatment regimens.
Mean Change From Baseline to Cycle 6 in Psychological General Well-Being Index (PGWBI)	Baseline up to Cycle 6 (28 days per Cycle)	Change from Baseline to Cycle 6 in PGWBI Questionnaire's assessment of participant's overall sense of well-being or distress. The PGWBI includes 22 items that, apart from combining into a global overall score, are divided into 6 dimensions: anxiety, depressed mood, positive well-being, self-control, health, and vitality. The response format used a 6-grade Likert scale and the change in the normalized PGWBI global score as well as all the sub-domains score ranges from -100 (worst) to 100 (best).
Mean Change From Baseline to Cycle 13 in Psychological General Well-Being Index (PGWBI)	Baseline up to Cycle 13 (28 days per Cycle)	Change from Baseline to Cycle 13 in PGWBI Questionnaire's assessment of participant's overall sense of well-being or distress. The PGWBI includes 22 items that, apart from combining into a global overall score, are divided into 6 dimensions: anxiety, depressed mood, positive well-being, self-control, health, and vitality. The response format used a 6-grade Likert scale and the change in the normalized PGWBI global score as well as all the sub-domains score ranges from -100 (worst) to 100 (best).
Mean Change From Baseline to Cycle 6 in Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) - Physical Health	Baseline up to Cycle 6 (28 days per Cycle)	Change from Baseline to Cycle 6 in the overall enjoyment and satisfaction experienced during the past week as scored on the Q-LES-Q (physical health - 13 items). 1-5 scale (very poor, poor, fair, good, very good). The normalized score ranges from 0 (worst) to 100 (best). The change in the normalized score ranges from -100 (worst) to 100 (best).
Mean Change From Baseline to Cycle 13 in Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) - Physical Health	Baseline up to Cycle 13 (28 days per Cycle)	Change from Baseline to Cycle 13 in the overall enjoyment and satisfaction experienced during the past week as scored on the Q-LES-Q (physical health - 13 items). 1-5 scale (very poor, poor, fair, good, very good). The normalized score ranges from 0 (worst) to 100 (best). The change in the normalized score ranges from -100 (worst) to 100 (best).
Mean Change From Baseline to Cycle 6 in Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) - Participant Feeling	Baseline up to Cycle 6 (28 days per Cycle)	Change from Baseline to Cycle 6 in the overall enjoyment and satisfaction experienced during the past week as scored on the Q-LES-Q (participant feeling - 14 items). 1-5 scale (very poor, poor, fair, good, very good). The normalized score ranges from 0 (worst) to 100 (best). The change in the normalized score ranges from -100 (worst) to 100 (best).
Mean Change From Baseline to Cycle 13 in Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) - Participant Feeling	Baseline up to Cycle 13 (28 days per Cycle)	Change from Baseline to Cycle 13 in the overall enjoyment and satisfaction experienced during the past week as scored on the Q-LES-Q (participant feeling - 14 items). 1-5 scale (very poor, poor, fair, good, very good). The normalized score ranges from 0 (worst) to 100 (best). The change in the normalized score ranges from -100 (worst) to 100 (best).
Mean Change From Baseline to Cycle 6 in Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) - Work	Baseline up to Cycle 6 (28 days per Cycle)	Change from Baseline to Cycle 6 in the overall enjoyment and satisfaction experienced during the past week as scored on the Q-LES-Q (work - yes or no; if yes, then 4 choices, and 13 items with a scale of 1-5 \[very poor, poor, fair, good, very good\]). The normalized score ranges from 0 (worst) to 100 (best). The change in the normalized score ranges from -100 (worst) to 100 (best).
Mean Change From Baseline to Cycle 13 in Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) - Work	Baseline up to Cycle 13 (28 days per Cycle)	Change from Baseline to Cycle 13 in the overall enjoyment and satisfaction experienced during the past week as scored on the Q-LES-Q (work - yes or no; if yes, then 4 choices, and 13 items with a scale of 1-5 \[very poor, poor, fair, good, very good\]). The normalized score ranges from 0 (worst) to 100 (best). The change in the normalized score ranges from -100 (worst) to 100 (best).
Mean Change From Baseline to Cycle 6 in Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) - Household Duties	Baseline up to Cycle 6 (28 days per Cycle)	Change from Baseline to Cycle 6 in the overall enjoyment and satisfaction experienced during the past week as scored on the Q-LES-Q (household duties - yes or no; if yes, then 4 choices, and 10 items with a scale of 1-5 \[very poor, poor, fair, good, very good\]). The normalized score ranges from 0 (worst) to 100 (best). The change in the normalized score ranges from -100 (worst) to 100 (best).
Mean Change From Baseline to Cycle 13 in Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) - Household Duties	Baseline up to Cycle 13 (28 days per Cycle)	Change from Baseline to Cycle 13 in the overall enjoyment and satisfaction experienced during the past week as scored on the Q-LES-Q (household duties - yes or no; if yes, then 4 choices, and 10 items with a scale of 1-5 \[very poor, poor, fair, good, very good\]). The normalized score ranges from 0 (worst) to 100 (best). The change in the normalized score ranges from -100 (worst) to 100 (best).
Mean Change From Baseline to Cycle 6 in Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) - School/Course Work	Baseline up to Cycle 6 (28 days per Cycle)	Change from Baseline to Cycle 6 in the overall enjoyment and satisfaction experienced during the past week as scored on the Q-LES-Q (school / course work - yes or no; if yes, then 4 choices, and 10 items with a scale of 1-5 (very poor, poor, fair, good, very good). The normalized score ranges from 0 (worst) to 100 (best). The change in the normalized score ranges from -100 (worst) to 100 (best).
Mean Change From Baseline to Cycle 13 in Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) - School/Course Work	Baseline up to Cycle 13 (28 days per Cycle)	Change from Baseline to Cycle 13 in the overall enjoyment and satisfaction experienced during the past week as scored on the Q-LES-Q (school / course work - yes or no; if yes, then 4 choices, and 10 items with a scale of 1-5 (very poor, poor, fair, good, very good). The normalized score ranges from 0 (worst) to 100 (best). The change in the normalized score ranges from -100 (worst) to 100 (best).
Mean Change From Baseline to Cycle 6 in Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) - Leisure Time Activities	Baseline up to Cycle 6 (28 days per Cycle)	Change from Baseline to Cycle 6 in the overall enjoyment and satisfaction experienced during the past week as scored on the Q-LES-Q (leisure time activities - 6 items). 1-5 scale (very poor, poor, fair, good, very good). The normalized score ranges from 0 (worst) to 100 (best). The change in the normalized score ranges from -100 (worst) to 100 (best).
Percentage of Participants With Improvement in the Participant's Assessment in Clinical Global Impression (CGI) at Cycle 6	At Cycle 6 (28 days per Cycle)	In 1 section of the CGI the subject rates their total improvement and rate of satisfaction with sexuality during treatment. The assessment scale ranges from 0 to 7: (0=not assessed; 1=very much improved; 2=much improved; 3=minimally improved; 4=no change; 5=minimally worse; 6=much worse; 7=very much worse). The scale of 1, 2, and 3 were categorized as improvement.
Percentage of Participants With Improvement in the Participant's Assessment in Clinical Global Impression (CGI) at Cycle 13	At Cycle 13 (28 days per Cycle)	In 1 section of the CGI the subject rates their total improvement and rate of satisfaction with sexuality during treatment. The assessment scale ranges from 0 to 7: (0=not assessed; 1=very much improved; 2=much improved; 3=minimally improved; 4=no change; 5=minimally worse; 6=much worse; 7=very much worse). The scale of 1, 2, and 3 were categorized as improvement.
Mean Change From Baseline to Cycle 13 in Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) - Leisure Time Activities	Baseline up to Cycle 13 (28 days per Cycle)	Change from Baseline to Cycle 13 in the overall enjoyment and satisfaction experienced during the past week as scored on the Q-LES-Q (leisure time activities - 6 items). 1-5 scale (very poor, poor, fair, good, very good). The normalized score ranges from 0 (worst) to 100 (best). The change in the normalized score ranges from -100 (worst) to 100 (best).
Mean Change From Baseline to Cycle 6 in Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) - Social Relationship	Baseline up to Cycle 6 (28 days per Cycle)	Change from Baseline to Cycle 6 in the overall enjoyment and satisfaction experienced during the past week as scored on the Q-LES-Q (social relationship - 11 items). 1-5 scale (very poor, poor, fair, good, very good). The normalized score ranges from 0 (worst) to 100 (best). The change in the normalized score ranges from -100 (worst) to 100 (best).
Mean Change From Baseline to Cycle 13 in Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) - Social Relationship	Baseline up to Cycle 13 (28 days per Cycle)	Change from Baseline to Cycle 13 in the overall enjoyment and satisfaction experienced during the past week as scored on the Q-LES-Q (social relationship - 11 items). 1-5 scale (very poor, poor, fair, good, very good). The normalized score ranges from 0 (worst) to 100 (best). The change in the normalized score ranges from -100 (worst) to 100 (best).
Mean Change From Baseline to Cycle 6 in Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) - General Activities	Baseline up to Cycle 6 (28 days per Cycle)	Change from Baseline to Cycle 6 in the overall enjoyment and satisfaction experienced during the past week as scored on the Q-LES-Q (general activities - 16 items). 1-5 scale (very poor, poor, fair, good, very good). The normalized score ranges from 0 (worst) to 100 (best). The change in the normalized score ranges from -100 (worst) to 100 (best).
Mean Change From Baseline to Cycle 13 in Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) - General Activities	Baseline up to Cycle 13 (28 days per Cycle)	Change from Baseline to Cycle 13 in the overall enjoyment and satisfaction experienced during the past week as scored on the Q-LES-Q (general activities - 16 items). 1-5 scale (very poor, poor, fair, good, very good). The normalized score ranges from 0 (worst) to 100 (best). The change in the normalized score ranges from -100 (worst) to 100 (best).
Mean Change From Baseline to Cycle 6 in Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) - Item Satisfaction	Baseline up to Cycle 6 (28 days per Cycle)	Change from Baseline to Cycle 6 in the overall enjoyment and satisfaction experienced during the past week as scored on the Q-LES-Q (item satisfaction). 1-5 scale (very poor, poor, fair, good, very good). The normalized score ranges from 0 (worst) to 100 (best). The change in the normalized score ranges from -100 (worst) to 100 (best).
Mean Change From Baseline to Cycle 13 in Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) - Item Satisfaction	Baseline up to Cycle 13 (28 days per Cycle)	Change from Baseline to Cycle 13 in the overall enjoyment and satisfaction experienced during the past week as scored on the Q-LES-Q (item satisfaction). 1-5 scale (very poor, poor, fair, good, very good). The normalized score ranges from 0 (worst) to 100 (best). The change in the normalized score ranges from -100 (worst) to 100 (best).
Mean Change From Baseline to Cycle 6 in Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) - Overall Life Satisfaction and Contentment	Baseline up to Cycle 6 (28 days per Cycle)	Change from Baseline to Cycle 6 in the overall enjoyment and satisfaction experienced during the past week as scored on the Q-LES-Q (overall life satisfaction and contentment). 1-5 scale (very poor, poor, fair, good, very good). The normalized score ranges from 0 (worst) to 100 (best). The change in the normalized score ranges from -100 (worst) to 100 (best).
Mean Change From Baseline to Cycle 13 in Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) - Overall Life Satisfaction and Contentment	Baseline up to Cycle 13 (28 days per Cycle)	Change from Baseline to Cycle 13 in the overall enjoyment and satisfaction experienced during the past week as scored on the Q-LES-Q (overall life satisfaction and contentment). 1-5 scale (very poor, poor, fair, good, very good). The normalized score ranges from 0 (worst) to 100 (best). The change in the normalized score ranges from -100 (worst) to 100 (best).
Percentage of Participants With Improvement in the Investigator's Assessment in Clinical Global Impression (CGI) at Cycle 6	At Cycle 6 (28 days per Cycle)	CGI is used to collect information regarding the subject's total clinical experience. The assessment scale ranges from 0 to 7: (0=not assessed; 1=very much improved; 2=much improved; 3=minimally improved; 4=no change; 5=minimally worse; 6=much worse; 7=very much worse). The scale of 1, 2, and 3 were categorized as improvement.
Percentage of Participants With Improvement in the Investigator's Assessment in Clinical Global Impression (CGI) at Cycle 13	At Cycle 13 (28 days per Cycle)	CGI is used to collect information regarding the subject's total clinical experience. The assessment scale ranges from 0 to 7: (0=not assessed; 1=very much improved; 2=much improved; 3=minimally improved; 4=no change; 5=minimally worse; 6=much worse; 7=very much worse). The scale of 1, 2, and 3 were categorized as improvement.

Other

Measure	Time frame	Description
Percentage of Participants With no Increase in Rescue Medication and VAS Decrease During Cycle Days 22 to 28 From Baseline to Cycle 6	Day 22-28 from Baseline to Day 22-28 from Cycle 6 (28 days per Cycle)	Rescue medication was standardized intake of 200 mg Ibuprofen tablets. Baseline: 7 days (Day 22) before first menstrual bleeding to Day 28. Treatment: 7 days (Day 22) before withdrawal bleeding of 6th cycle to Day 28 before the same cycle. The visual analog scale (VAS) is a subject-assessed measure of pelvic pain or headache consisting of a 100 mm long straight line, with verbal anchors at either end, representing a continuum of pain intensity. Accordingly, the scale ranges from 0 mm (absence of pain) to 100 mm (unbearable pain), and the change ranges from -100 mm (best) to 100 mm (worst).
The Change of Pelvic Pain or Headache as Determined by the Highest Visual Analog Scale (VAS) Values During Cycle Days 22 to 28 From Baseline to Cycle 6	Days 22-28 from Baseline to Days 22-28 from Cycle 6 (28 days per Cycle)	Subject self-assessed pelvic pain or headache per visual analog scale (VAS) values during the menstrual/withdrawal bleeding episode and Baseline. The VAS consists of a 100 mm long straight line, with verbal anchors at either end, representing a continuum of pain intensity. Accordingly, the scale ranges from 0 mm (absence of pain) to 100 mm (unbearable pain), and the change ranges from -100 mm (best) to 100 mm (worst).

Countries

Canada, United States

Participant flow

Recruitment details

The date of first subject first visit was 08 Sep 2008. The date of last subject last visit was 10 May 2011.

Pre-assignment details

A total of 776 participants were screened; 367 failed Screening, and 409 were randomized 1:1, of which 14 never received treatment, and 395 were treated (EV/DNG=191; EE/NGM=204). A total of 203 subjects (99 received EV/DNG and 104 EE/NGM) in the US and 192 (92 received EV/DNG and 100 EE/NGM) in Canada received at least one dose of the study drug.

Participants by arm

Arm	Count
Estradiol Valerate, Dienogest (Natazia, Qlaira, BAY86-5027) Daily oral administration of one capsule BAY86-5027 \[estradiol valerate (EV) / dienogest (DNG)\] for 26 days, followed by one capsule placebo for 2 days (28 days total per cycle) for 13 treatment cycles (treatment encapsulated)	191
Ortho Tri-Cyclen Lo Daily oral administration of one capsule Ortho Tri-Cyclen Lo \[Ethinylestradiol (EE)/ Norgestimate (NGM)\] for 21 days, followed by one capsule placebo for 7 days (28 days total per cycle) for 13 treatment cycles (treatment encapsulated)	204
Total	395

Withdrawals & dropouts

Period	Reason	FG000	FG001
Overall Study	Adverse Event	19	25
Overall Study	Lost to Follow-up	7	11
Overall Study	Never received treatment	12	2
Overall Study	Pregnancy	6	0
Overall Study	Protocol Violation	12	10
Overall Study	Reason not specified or unknown, etc.	21	27
Overall Study	Withdrawal by Subject	4	5

Baseline characteristics

Characteristic	Estradiol Valerate, Dienogest (Natazia, Qlaira, BAY86-5027)	Ortho Tri-Cyclen Lo	Total
Age, Continuous	26.0 Years STANDARD_DEVIATION 6.6	26.5 Years STANDARD_DEVIATION 7.2	26.3 Years STANDARD_DEVIATION 6.9
Race/Ethnicity, Customized Asian	4 Participants	2 Participants	6 Participants
Race/Ethnicity, Customized Black	9 Participants	9 Participants	18 Participants
Race/Ethnicity, Customized Caucasian	168 Participants	180 Participants	348 Participants
Race/Ethnicity, Customized Hispanic	6 Participants	10 Participants	16 Participants
Race/Ethnicity, Customized Other	4 Participants	3 Participants	7 Participants
Sex: Female, Male Female	191 Participants	204 Participants	395 Participants
Sex: Female, Male Male	0 Participants	0 Participants	0 Participants

Adverse events

Event type	EG000 affected / at risk	EG001 affected / at risk
deaths Total, all-cause mortality	— / —	— / —
other Total, other adverse events	154 / 191	159 / 204
serious Total, serious adverse events	2 / 191	5 / 204

Outcome results

Primary

The Change in Average of the 3 Highest Visual Analog Scale (VAS) Values of the Hormone Withdrawal-associated Symptoms Pelvic Pain or Headache During Cycle Days 22 to 28 From Baseline to Cycle 6

Subject self-assessed pelvic pain or headache per visual analog scale (VAS) values during the menstrual/withdrawal bleeding episode and Baseline. The VAS consists of a 100 mm long straight line, with verbal anchors at either end, representing a continuum of pain intensity. Accordingly, the scale ranges from 0 mm (absence of pain) to 100 mm (unbearable pain), and the change ranges from -100 mm (best) to 100 mm (worst).

Time frame: Day 22-28 from Baseline to Day 22-28 from Cycle 6 (28 days per Cycle)

Population: All participants in Full Analysis Set (FAS) with assessment for this outcome measure

Arm	Measure	Value (MEAN)	Dispersion
Estradiol Valerate, Dienogest (Natazia, Qlaira, BAY86-5027)	The Change in Average of the 3 Highest Visual Analog Scale (VAS) Values of the Hormone Withdrawal-associated Symptoms Pelvic Pain or Headache During Cycle Days 22 to 28 From Baseline to Cycle 6	43.05 mm	Standard Deviation 23.58
Ortho Tri-Cyclen Lo	The Change in Average of the 3 Highest Visual Analog Scale (VAS) Values of the Hormone Withdrawal-associated Symptoms Pelvic Pain or Headache During Cycle Days 22 to 28 From Baseline to Cycle 6	34.97 mm	Standard Deviation 25.9

Comparison: 2-way ANOVA model with treatment and pain strata (headache and pelvic pain) as factorsp-value: 0.0024ANOVA

Secondary