Background: Endometriosis is a chronic, estrogen-dependent condition characterized by the presence of endometrial glands and stroma outside the uterus, leading to significant pelvic pain and infertility in many women of reproductive age. Dienogest a fourth-generation progestin and gonadotropin releasing hormone (GnRH) analogues are commonly used in the treatment of endometriosis. Objective: To compare the efficacy of Dienogest versus GnRH analogues in the treatment of pelvic pain associated with endometriosis.Data Sources: PubMed and Google Scholar were systematically searched till June 2024.Study Selection: The meta-analysis incuded all published Randomised controlled trials that investigated the efficacy of Dienogest over GnRH analogues in the treatment of pelvic pain associated with endometriosis.Data extraction: Data extraction was guided by a predetermined checklist.Analytical approach: Using RevMan 5 software, the mean VAS score and adverse events after treatment were pooled from the selected studies. The random-effect model was used to compare the mean VAS score and the adverse events in the Dienogest and GnRH group.Data analyses were performed in July 2024.Main Outcomes and Measures: The primary outcome was to explore the effect of dienogest when compared to GnRH analogue in alleviating pain associated with endometriosis. The secondary outcome was to measure the adverse events in both intervention and control groups.Results: The initial search yielded 517 records of which 106 articles underwent full-text evaluation, which identified four articles and a total of 770 patients were included. Dienogest is equally effective as GnRH analogue in reducing the pain associated with endometriosis (Odds ratio = 0.97, 95% CI 0.52-1.78, p=0.91). An insignificant Q statistic (p >0.001) indicated the absence of heterogeneity (I2 0%). The findings also suggested less adverse events with Dienogest when compared to GnRH analogue (Odds ratio 0.05,95%CI 0.00-0.510, p= 0.01). A significant Q statistic (p<0.00001) indicated the presence of heterogeneity I2 =95%.Conclusion: This systematic review and meta-analysis demonstrated that Dienogest is equally effective with GnRH analogues in the treatment of pain associated with endometriosis with less adverse effects in dienogest than GnRH analogues. Trail Registration: PROSPERO Registration No CRD42024572359.