Endometriosis Treatment: Hormonal Medications, Oral Contraceptives, and Surgical Options for Pain Management

Endometriosis is a chronic condition affecting approximately 10% of women of reproductive age. It is characterized by the presence of endometrial tissue outside the uterus, leading to pelvic pain, dysmenorrhea, and often infertility. Despite its high prevalence, endometriosis treatment remains a challenge due to its complex pathogenesis and variability in symptom presentation.

Treatment Options: Hormonal Medications and Surgery

The management of endometriosis focuses on pain management and improving the quality of life for patients. Combined oral contraceptives and GnRH analogs are first-line options for hormonal treatment. These medications work by suppressing ovulation and reducing estrogen levels, which decreases the growth of endometriotic lesions and alleviates pain. A recent study has shown that combination therapy with relugolix, a GnRH receptor antagonist, along with estradiol and norethisterone acetate, significantly improves pain associated with endometriosis and is well tolerated by patients [1].

Regarding surgical options, laparoscopic surgery remains the gold standard for the diagnosis and treatment of endometriosis. Laparoscopy allows for direct visualization and removal of endometriotic lesions, which can improve fertility rates and relieve pain. However, disease recurrence is common, and a multidisciplinary approach is recommended for long-term management [2]. In cases of severe endometriosis or when conservative treatments fail, hysterectomy may be considered as a definitive option [3].

Conclusions

The treatment of endometriosis requires a personalized approach that considers both pharmacological and surgical options. Oral contraceptives and GnRH analogs provide pain relief and disease control, while laparoscopic surgery offers a more direct solution for the removal of lesions. The choice of treatment should be based on the severity of symptoms, the desire for fertility, and the response to previous therapies. Ongoing research and the development of new therapies are essential to improve outcomes for patients with endometriosis [4].

Referencias

• [1] Relugolix/Estradiol/Norethisterone Acetate: A Review in Endometriosis-Associated Pain
• [2] Endometriosis: Classification, pathophysiology, and treatment options
• [3] Once daily oral relugolix combination therapy versus placebo in patients with endometriosis-associated pain: two replicate phase 3, randomised, double-blind, studies (SPIRIT 1 and 2)
• [4] Endometriosis Associated Infertility: A Critical Review and Analysis on Etiopathogenesis and Therapeutic Approaches

Created 6/1/2025