{"paper_id":"1b6d18fb-bca9-4575-9ef5-79774092289d","body_text":"ABSTRACT\nIntroduction\nEndometriosis is a chronic inflammatory condition affecting ~10% of reproductive-age individuals and contributing significantly to infertility, pain, and reduced quality of life. Since our 2020 review, new pharmacologic strategies, updated guidelines, and advances in clinical trial evidence have reshaped the therapeutic landscape. Effective, patient-centered management is essential to lessen the burden of disease.\nAreas covered\nThis review synthesizes current evidence-based pharmacotherapy for endometriosis, integrating 2022 European Society of Human Reproduction and Embryology recommendations and including a literature review of PubMed, with an emphasis on articles published after 2020. First-line therapies, including NSAIDs, combined oral contraceptives, and progestins such as dienogest, remain central, while GnRH agonists/antagonists and aromatase inhibitors are considered in refractory cases. Recent data highlight add-back therapy to reduce hypoestrogenic side effects. We also review postoperative regimens, fertility-preserving strategies, management in post-hysterectomy and postmenopausal populations, and therapies under investigation – including anti-inflammatory, antifibrotic, angiogenesis-modulating, and microbiome-targeting approaches.\nExpert opinion\nHormonal suppression remains the cornerstone of treatment, but novel nonhormonal strategies and advances in precision medicine hold promise for more durable and individualized care. Ongoing clinical trials, artificial intelligence – assisted diagnostics, and fertility-focused pharmacotherapies represent exciting frontiers. Multimodal, patient-tailored approaches will be key to optimizing long-term outcomes in endometriosis management.\nArticle highlights\nSince 2020, updated clinical guidelines and emerging pharmacologic data have reshaped endometriosis management strategies.\nFirst-line therapies – including NSAIDs, combined oral contraceptives, and progestins such as dienogest – remain central to symptom control.\nGnRH agonists/antagonists, aromatase inhibitors, and add-back therapy play key roles in refractory or long-term treatment.\nNovel therapeutic avenues include anti-inflammatory, antifibrotic, angiogenesis-modulating, and microbiome-targeting agents.\nFuture management will emphasize precision medicine, nonhormonal options, and AI-assisted, fertility-focused, patient-tailored approaches.\nDeclaration of interests\nThe authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.\nReviewer disclosures\nPeer reviewers on this manuscript have no relevant financial or other relationships to disclose.\nSupplementary material\nSupplemental data for this article can be accessed online at https://doi.org/10.1080/14656566.2025.2597272","source_license":"CC0","license_restricted":false}