Medical treatment of endometriosis-related pain

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)68-91
JournalBest Practice and Research: Clinical Obstetrics and Gynaecology
Publication statusPublished - 2018


  • Endometriosis
  • GnRH agonists
  • GnRH antagonists
  • Oral contraceptives
  • Pelvic pain
  • Progestogens

ASJC Scopus subject areas

  • Obstetrics and Gynaecology


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