Medical treatment of endometriosis-related pain

Best Pract Res Clin Obstet Gynaecol. 2018 Aug:51:68-91. doi: 10.1016/j.bpobgyn.2018.01.015. Epub 2018 Feb 15.


Available medical treatments for symptomatic endometriosis act by inhibiting ovulation, reducing serum oestradiol levels, and suppressing uterine blood flows. For this, several drugs can be used with a similar magnitude of effect, in terms of pain relief, independently of the mechanism of action. Conversely, safety, tolerability, and cost differ. Medications for endometriosis can be categorized into low-cost drugs including oral contraceptives (OCs) and most progestogens, and high-cost drugs including dienogest and GnRH agonists. As the individual response to different drugs is variable, a stepwise approach is suggested, starting with OCs or low-cost progestogens, and stepping up to high-cost drugs only in case of inefficacy or intolerance. OCs may be used in women with dysmenorrhea as their main complaint, and when only superficial peritoneal implants or ovarian endometriomas <5 cm are present, while progestogens should be preferred in women with severe deep dyspareunia and when infiltrating lesions are identified.

Keywords: Endometriosis; GnRH agonists; GnRH antagonists; Oral contraceptives; Pelvic pain; Progestogens.

Publication types

  • Review

MeSH terms

  • Chronic Pain / drug therapy*
  • Chronic Pain / etiology
  • Contraceptives, Oral / therapeutic use*
  • Dysmenorrhea / drug therapy
  • Dyspareunia / drug therapy
  • Endometriosis / classification
  • Endometriosis / complications
  • Endometriosis / drug therapy*
  • Female
  • Gonadotropin-Releasing Hormone / therapeutic use
  • Humans
  • Progestins / therapeutic use*
  • Quality of Life
  • Randomized Controlled Trials as Topic
  • Severity of Illness Index


  • Contraceptives, Oral
  • Progestins
  • Gonadotropin-Releasing Hormone