{"paper_id":"8c2c0ee8-da47-4fdc-b3a0-632e6903f2a4","body_text":"REVIEW | OPEN ACCESS   \n \nMedical Science 30, e114ms3857 (2026)                                                                                                                                                                    1 of 8 \n \n Gonadotropin-releasing hormone \nantagonism treatment of \nendometriosis - new perspectives  \n \nKatarzyna Markuszka1٭ ,Kinga Polityńska1, Klaudia \nSamuła1, Martyna Sarzyńska1, Mateusz Szabat2, Sylwia \nLepak1, Zuzanna Irzyk1, Dominika Ruszel1, Emilia Goc1, \nJulia Rogała1 \n  \n \n \nABSTRACT \nEndometriosis is an inflammatory, estrogen-dependent disorder that affects women \nof reproductive age. Pain management continues as a challenge as there has been \nlimited progress in this area; however, oral GnRH antagonists are proving to be \npotent, safe, and well -tolerated options. The objectives of this paper were to \nevaluate the efficacy. and tolerability of the GnRH antagonists (relugolix, elagolix, \nlinzagolix) for pain associated with endometriosis, and to determine their effects on \npatients' occupational functioning. Researchers analyzed patient -reported \noutcomes, adherence, and the long -term benefits of these drugs in light of the need \nfor individualized therapies. To be eligible, patients had to have at least one of the \nfollowing endpoints: pain reduction, safety profile, or impact on occupational \nfunctioning. Phase III clinical trials demonstrated that combination therapy with \nrelugolix significantly reduced the severity of dysmenorrhea and non -menstrual \npelvic pain compared with placebo. Researchers showed that relugolix is as \neffective as leuprorelin. However, relugolix has a better safety profile. Patients \nexperienced fewer vasomotor symptoms and lower bone mineral density loss. \nStudies also demonstrated that elagolix improved work performance. It reduced \nabsenteeism and presenteeism, which resulted in financial benefits for both \nemployers and patients. GnRH antagonists are an effective and safe therapeutic \noption for the treatment of endometriosis -associated pain. In addition to improving \nclinical outcomes, their use has been shown to improve occupational functioning \nsignificantly. These therapies may play a key role in the long -term, individualized \nmanagement of endometriosis, offering an alternative to traditional hormonal and \nsurgical treatments and consequently broadening therapeutic options. \n  \nKeywords: endometriosis, relugolix, linzagolix, elagolix, GnRH antagonist \n \n \n \n1. INTRODUCTION  \nEndometriosis is a gynecological condition, chronic, inflammatory that affects about \n10% of women of reproductive age and 2 –4% of postmenopausal women \nworldwide. The pathomechanism of this disease involves the growth of uterine \nlining tissue outside the uterine cavity and the muscular layer, leading to a chronic \nMedical Science \n \nTo Cite: \nMarkuszka K, Polityńska K, Samuła K, Sarzyńska M, Szabat M, Lepak \nS, Irzyk Z, Ruszel D, Goc E, Rogała J. Gonadotropin-releasing \nhormone antagonism treatment of endometriosis - new perspectives. \nMedical Science 2026; 30: e114ms3857 \ndoi: https://doi.org/10.54905/disssi.v30i172.e114ms3857  \n \nAuthors’ Affiliation: \n1Faculty of Medicine, University of Rzeszów, Rzeszów, Poland.  \n2Clinical Provincial Hospital No. 2, Rzeszów, Poland. \n \n⃰ Corresponding author: \nKatarzyna Markuszka, \nFaculty of Medicine, University of Rzeszów, Rzeszów, Poland, \nE-mail address: kasiulamarkuszka@gmail.com \n \nPeer-Review History \nReceived: 18 February 2026 \nReviewed & Revised: 03/March/2026 to 16/June/2026 \nAccepted: 21 June 2026 \nPublished: 29 June 2026 \n \nPeer-review Method \nExternal peer-review was done through double-blind method. \n \nMedical Science \npISSN 2321–7359; eISSN 2321–7367 \n \n \n© The Author(s) 2026. Open Access. This article is licensed under a Creative Commons \nAttribution License 4.0 (CC BY 4.0)., which permits use, sharing, adaptation, distribution and \nreproduction in any medium or format, as long as you give appropriate credit to the original \nauthor(s) and the source, provide a link to the Creative Commons license, and indicate if \nchanges were made. To view a copy of this license, visit \nhttp://creativecommons.org/licenses/by/4.0/. \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nDISCOVERY \nSCIENTIFIC SOCIETY \n \n\n \nREVIEW | OPEN ACCESS   \n \nMedical Science 30, e114ms3857 (2026)                                                                                                                                                                    2 of 8 \ninflammatory reaction. Endometriosis is an estrogen -dependent disease, so ectopic tissue produces menstrual material in sync with a \nwoman's cycle, which accumulates in abnormal locations. Abnormal tissue and the normal uterine lining secrete and develop in a \nmanner very similar to the normal uterine lining (Ellis et al., 2022). The pathogenesis of endometriosis remains largely unkn own and is \nthe subject of intense scientific research. Scientists have presented many hypotheses to explain the development of endometri osis – \nmechanistic theories that explain the mechanisms underlying the disease, particularly the ability of endometrial cells to imp lant and \nproliferate in the peritoneal cavity and to spread beyond the pelvic area.   \nThe most prominent theories include: the transplantation theory proposed by Sampson (based on the phenomenon of retrograde \nmenstruation through the fallopian tubes, observed in nearly all women, which may result in the implantation of endometrial \nfragments in ectopic locations), the metaplasia theory by Waldeyer, the induction theory by Levander and Norman, and the tiss ue \ninjury and repair (TIAR) theory proposed by Leyendecker and Kunz. However, none of these theories fully accounts for the comp lexity \nof the disease's clinical and biological features, denoting a multifactorial etiopathogenesis (Zondervan et al., 2020). Endom etriosis is \nclinically classified into three main types. Superficial peritoneal endometriosis includes small lesions located within the p elvic cavity. \nOvarian endometriosis is associated with the presence of endometriomas. Deeply infiltrating endometriosis refers to lesions e xtending \nat least 5 mm below the peritoneal surface. Endometriotic lesions may also occur in extrapelvic locations, including the inte stines, \ndiaphragm, urinary bladder, thoracic wall, abdominal wall, as well as the peripheral and central nervous systems (Saunders and Horne, \n2021).  \nPatients who suffer from endometriosis report painful periods, chronic pelvic pain, pain during intercourse, pain during bowe l \nmovements (dyschezia) or urination (dysuria), constipation, diarrhea, chronic fatigue, and depression are symptoms of endomet riosis \n(Abulughod et al., 2024). Infertility affects up to 50% of patients. The symptoms mentioned above have a significant impact o n quality \nof life and work performance (Della Corte et al., 2020). Epidemiological studies indicate an increased risk of selected malig nancies \n(ovarian cancer, breast cancer, and melanoma) in women with endometriosis.  \nEndometriosis is also associated with several comorbidities. Common examples include autoimmune diseases, allergies, irritabl e \nbowel syndrome, migraines, asthma, cardiovascular diseases, and other gynecological disorders (Kvaskoff et al., 2015). Classi fying \nendometriosis is difficult because people have different symptoms, and the severity of the disease does not always match how much \npain they feel (Chapron et al., 2022). Several systems are used to classify the disease, including the revised American Socie ty for \nReproductive Medicine (rASRM) score (which measures lesion size, location, extent, and adhesions); the ENZIAN classification (which \nfocuses on the shape and depth of lesions); the Endometriosis Fertility Index (EFI); and the latest system from the American Association \nof Gynecologic Laparoscopists (Pašalić et al., 2023).  \nEndometriosis treatment is multifaceted. Treatment includes pharmacotherapy, surgical procedures, and supportive care. Modern  \ntherapeutic methods emphasize a personalized approach to each patient. They focus on the patient's uniqueness —their reproductive \ngoals, age, and symptoms. Hormone therapy is the cornerstone of conservative treatment and is the first step. Its main purpos e is to \nprevent ectopic endometrial tissue from growing by altering brain hormone signals and reducing estrogen levels. The most comm on \ndrugs are combined oral contraceptives. These prevent ovulation and stabilize the uterine lining, which lessens pain. Progest ogens \n(such as dienogest, medroxyprogesterone acetate, and norethindrone acetate) are another option. Progestogens inhibit endometr ial \nproliferation and modify uterine tissue. Thereby contributing to reduced pain, inflammation, and lesion regression (Kim et al ., 2024). If \nthe effect of these drugs proves ineffective, they are changed to analogs or antagonists of gonadotropin -releasing hormone. Mentioned \nabove medications lower the production of gonadotropins, which in turn creates a low -estrogen (hypoestrogenic) state. Although \ngonadotropin-releasing hormone analogs help alleviate symptoms, they have side effects. Doctors must combine GnRH with other \nmedications or shorten their duration of administration (Othman et al., 2024).  \nIn recent years, oral gonadotropin-releasing hormone antagonists such as elagolix, relugolix, and linzagolix have become a source of \ninterest for many researchers, because these medications work fast. Allow doctors to control hormones precisely. They have be en \nshown to reduce pain and are safer than the older gonadotropin -releasing hormone analogs (Wang et al., 2025). Relugolix is a non -\npeptide gonadotropin-releasing hormone receptor antagonist that works by binding to gonadotropin -releasing hormone receptors in \nthe pituitary gland, thereby preventing the natural gonadotropin -releasing hormone from binding. This interaction leads to a \nreversible, dose-dependent suppression of luteinizing hormone and follicle -stimulating hormone secretion, as well as reduced ovarian \nproduction of progesterone and estradiol (Miwa et al., 2011). Linzagolix is an orally active, non -peptide GnRH receptor antagonist. The \nhalf-life is approximately 15–18 hours. The substance is readily absorbed after oral administration and is poorly distributed throughout \n\n \nREVIEW | OPEN ACCESS   \n \nMedical Science 30, e114ms3857 (2026)                                                                                                                                                                    3 of 8 \nthe body. The drug's absorption is independent of food intake and has no significant effect on typical liver enzymes or trans port \nproteins (Pohl et al., 2018). \n \n2. REVIEW METHODS \nWe have searched the PubMed//MEDLINE and the National Institutes of Health (NIH) database for scientific articles published \nbetween January 2016 and January 2026 using the different combinations of the following MeSH terms and keywords: \"endometrios is,\" \n\"GnRH antagonist,\" \"relugolix,\" \"elagolix,\" and \"linzagolix.\" Individual terms were combined using the Boolean operators \"AND \" and \n\"OR.\" We selected meta -analyses, randomized controlled trials, prospective and retrospective observational studies, and case reports. \nDuring the selection of searched articles, we excluded animal model studies, papers without full -text access, and papers in languages \nother than English. We removed duplicate records before the inspection stage.  Finally, we enrolled 56 records. Then we selec ted \narticles for inclusion in the qualitative synthesis. The publication selection process was conducted according to the PRISMA 2020 \nguidelines to ensure methodological integrity (Figure 1). \n \n \nFigure 1. PRISMA flow diagram \n  \n3. RESULTS & DISCUSSION \nManagement of Endometriosis-Associated Pain \nThe researchers conducted a multicenter, randomized, double-blind, phase 3 clinical trial (SPIRIT 1). Inclusion criteria included women \naged between 18 and 50 years with a diagnosis of endometriosis confirmed histologically or surgically within the previous 10 years, \nand dysmenorrhea or non -menstrual pelvic pain rated 4 or more on the Numerical Rating Scale (0 = no pain; 10 = worst possible pain) \nduring the preceding month. A total of 638 patients participated in the SPIRIT 1 trial. Patients were divided into 3 groups: Relugolix \n\n\n \nREVIEW | OPEN ACCESS   \n \nMedical Science 30, e114ms3857 (2026)                                                                                                                                                                    4 of 8 \ncombination therapy (213 patients receiving Relugolix 40 mg, estradiol 1 mg, and norethisterone acetate 0.5 mg), placebo (213  patients), \nor delayed Relugolix combination therapy (213 patients receiving Relugolix monotherapy 40 mg followed by combination therapy,  \neach for 12 weeks).  The treatment period was 24 weeks. Ninety -eight patients discontinued the study prematurely. In the clinical trial, \nthe percentage of patients achieving a therapeutic response for dysmenorrhea was 158/212 (75%) in the relugolix combination t herapy \ngroup, compared with 57/212 (27%) in the placebo group, corresponding to a treatment effect difference of 47.6% (95% CI: 39.3 –56.0; p < \n0.0001). In the combined therapy group, 128/212 (58%) met the criterion for reduced nonmenstrual pelvic pain compared with 84/212 \n(40%) in the placebo group, resulting in a treatment difference of 18.9% (95% CI: 9.5 –28.2; p < 0.0001). The most commonly reported \nside effects were nasopharyngitis and hot flashes. The results confirm the significant efficacy of oral combination therapy with relugolix \nin relieving endometriosis-related pain and indicate its aptitude for long-term treatment of this disease (Giudice et al., 2022).  \nAnother multicenter, randomized, double -masked, active-controlled study was a phase III clinical trial in Japanese patients with \nendometriosis. Patients included in the study were ≥20 years old, had regular menstrual cycles lasting 25 –38 days, and had a diagnosis \nof endometriosis confirmed surgically, radiologically, or clinically.  Additional criteria included moderate to severe pelvic  pain or \ndysmenorrhea, as assessed by the Biberoglu  and Behrman scale, and a baseline visual analog scale (VAS) score >30. The study enrolled \n335 patients and randomized them 1:1 to receive relugolix (171 patients; 40 mg orally once daily) or leuprorelin (164 patient s; 3.75 mg \nor 1.88 mg subcutaneously every 4 weeks) for 24 weeks.  Sixteen patients discontinued engagement due to adverse events. With respect \nto the primary endpoint—change in maximum pelvic pain intensity measured using the VAS—both groups manifested significant pain \nreduction: −52.6 ± 1.3 in the relugolix group and −57.5 ± 1.4 in the leuprorelin group. The maximum value of the 95% confiden ce \ninterval for the difference between groups was 8.7, which was below the predefined noninferiority margin (Δ = 10), thereby co nfirming \nthe noninferiority of relugolix compared to leuprorelin. Pain reduction was observed as early as the first month of treatment  and was \nmaintained consistently throughout the study period. The results of the study showed that Oral relugolix therapy is as effect ive as \nstandard GnRH analog therapy in relieving endometriosis-related pain. It can represent a potential long-term treatment option (Harada \net al., 2022).  \n \nTable 1. Summary of the mechanisms of action of GnRH antagonists and their clinical effects \nMechanism of action Description Clinical benefits \nCompetitive blockade  \nof GnRH receptors in the pituitary \nGnRH antagonists directly block GnRH \nreceptors, leading to immediate suppression \nof LH and FSH secretion \nRapid and reversible suppression of the \nHPG axis and reduction  \nof estrogen levels \nSuppression of estrogen production \n(hypoestrogenism) \nDecreased LH/FSH → decreased ovarian \nstimulation → decreased estradiol \nReduced proliferation  \nof endometriotic lesions and pain relief \nNo “flare-up” effect Unlike GnRH agonists, there is no initial \nincrease in LH/FSH and estrogen levels No temporary worsening of symptoms \nDose-dependent effect (estradiol \nsuppression) \nDegree of estradiol suppression depends on \ndrug dose \nPossibility of individualized therapy \n(balance between efficacy and side \neffects) \nUse of add-back therapy Addition of low doses of estrogen/progestin Reduction of side effects (e.g., bone \nloss) while maintaining efficacy \nAnalgesic effect (via hormonal and \ninflammatory pathways) \nReduced estrogen levels lead to decreased \ninflammation and lesion activity \nReduced dysmenorrhea, chronic pelvic \npain, and dyspareunia \n \nAn international, multicenter, randomized, double -masked, placebo-controlled phase IIb clinical trial (EDELWEISS) was conducted \nto evaluate the efficacy and safety of linzagolix  and to determine the optimal dosing range in patients with endometriosis -associated \npain. Inclusion criteria for the study were gender, age 18 –45 years, premenopausal, with surgically confirmed endometriosis within the \nlast 10 years, and moderate to severe pelvic pain. A total of 328 patients were recruited, of whom 327 received at least one dose of the \ninvestigational medicinal product and were subsequently included in the safety analysis. Participants were equally assigned t o 6 \ntreatment groups: placebo (switching to linzagolix 100 mg after 12 weeks), a fixed dose of linzagolix (50 mg, 75 mg, 100 mg, or 200 mg), \nand a dose -titration regimen starting at 75 mg with subsequent adjustments based on estradiol levels.  The treatment duration was 24 \nweeks. The primary endpoint was a 30% or greater reduction in mean pelvic pain after 12 weeks of therapy. Secondary endpoints  \n\n \nREVIEW | OPEN ACCESS   \n \nMedical Science 30, e114ms3857 (2026)                                                                                                                                                                    5 of 8 \nincluded reductions in pain on bleeding and non -bleeding days, changes in the severity of dyspareunia and dyschezia , analgesic use, \nquality-of-life measures, and the frequency of amenorrhea. The results showed that linzagolix significantly relieved pain associated \nwith endometriosis. Effects that increase with dosage.  \nThe mechanism of action of linzagolix involves carefully lowering estradiol levels, consistent with the \"estrogen threshold\" concept -\nthis mechanism aids in maintaining pain relief while limiting hypoestrogenic side effects. Regarding treatment compliance, 88 .1% of \npatients completed 12 weeks of therapy, and 77.1% completed the full 24 -week period. Collectively, these results prove that linzagolix  \nis a beneficial therapeutic alternative. It has the advantages of being effective in treating endometriosis -related pain, providing effective \nsymptom relief, and potentially having a more favorable safety profile than conventional GnRH analogs (Taylor et al., 2017). Table 1 \nsummarizes the mechanisms of action of GnRH antagonists and their benefits (Dick et al., 2025; Othman et al., 2024). \n \nImpact of GnRH Antagonist Therapy on Work Productivity and Occupational Activity \nIn Patients with endometriosis, given the significant burden of pain associated with the condition, recent studies have assessed not only \nclinical outcomes but also the implications of treatment for patients' ability to maintain daily work activities and overall job \nproductivity. Table 2 summarizes the symptoms and their frequency in patients with endometriosis. \n \nTable 2. Summary of endometriosis symptoms and their prevalence \nSymptoms % Women with Endometriosis Notes \nDysmenorrhea 70–87% most common symptom \nChronic pelvic pain 50–80% often coexists with other \nsymptoms \nDyspareunia 30–70% depends on lesion location \nDyschezia 20–60% more common in bowel \nendometriosis \nDysuria 10-30% less common \nInfertility 30-50% very common manifestation \nSevere pain (high-intensity pain symptoms 60-68% refers to significant pain burden \nPsychological symptoms (anxiety, depression) 50-60% often underrecognized \nAsymptomatic 20-25% important for underdiagnosis \n \nA post hoc analysis was accomplished using data from two multicenter, randomized, placebo -controlled phase 3 clinical trials (EM-\nI: NCT01620528 and EM -II: NCT01931670) evaluating the efficacy of elagolix and its impact on work productivity in women with \nmoderate-to-severe endometriosis-associated pain. Participants were women aged 18–49 years with surgically confirmed endometriosis \nand moderate to severe disease -related pain. The analysis included working patients (full -time or part -time) from the intent -to-treat \npopulation: 672 in study EM -I and 626 in study EM -II. Participants were randomly assigned to one of three groups: placebo, elagolix \n150 mg once daily, or elagolix 200 mg twice daily for 6 months. The primary assessment was conducted three months after treat ment \nbegan.  \nThe study used the Health -Related Productivity Questionnaire (HRPQ) to assess work hours and activity limitations. The \nquestionnaire measures both absenteeism (time absent from work) and presenteeism (reduced work productivity). At baseline, th e \nmean weekly time lost from work was 16.5 ± 11.4 hours in the EM -I study and 15.2 ± 11.3 hours in the EM -II study, representing 45.3% \nand 43.7% of scheduled work time, respectively. The most important cause of the decline in productivity was presenteeism (aro und 12–\n13 hours per week), while absenteeism was around 3 hours per week. After three months of treatment, the elagolix groups showe d \nstatistically significant reductions in work productivity loss, including both absenteeism and presenteeism, compared to the placebo \ngroup (p < 0.05). Treatment was associated with reduced total lost work hours and improved occupational productivity. Effects  were \nobserved with both dosing regimens, but greater benefits were observed with the 200 mg twice -daily dose.  Additionally, an economic \nanalysis found that improved work productivity translated into prospective direct cost savings for employers, resulting from reduced \nlost working hours (Pokrzywiński et al., 2019). Table 3 summarizes the research from the above article. \n \n \n\n \nREVIEW | OPEN ACCESS   \n \nMedical Science 30, e114ms3857 (2026)                                                                                                                                                                    6 of 8 \nTable 3. Summary of the clinical studies described in the article. \nStudy Drug / intervention Population Key efficacy outcomes Clinical conclusions \nSPIRIT 1 (Giudice \net al., 2022) \nRelugolix + E2 + \nNETA vs placebo \nn = 638, \nendometriosis + \npain ≥4 NRS \nDysmenorrhea: 75% vs \n27% (Δ 47.6%, p<0.0001); \nNMPP: 58% vs 40% (Δ \n18.9%, p<0.0001) \nStrong analgesic \nefficacy; particularly in \ndysmenorrhea \nHarada et al., 2022 Relugolix vs \nleuprorelin n = 335 \nPain reduction: −52.6 vs \n−57.5 (VAS); non-\ninferiority achieved \nRelugolix is as effective \nas GnRH agonist \ntherapy \nEDELWEISS \n(Taylor et al.) \nLinzagolix \n(multiple doses) n = 328 ≥30% pain reduction; \ndose-dependent effect \nEnables estradiol \ncontrol (“estrogen \nthreshold”) \nEM-I / EM-II \n(Pokrzywiński et \nal., 2019) \nElagolix vs placebo n=1300 \nReduced work \nproductivity impairment \nand improved functional \ncapacity (p < 0.05) \nDemonstrates real-\nworld functional and \neconomic benefits \n \n \n4. CONCLUSION \nClinical trial results show that oral gonadotropin -releasing hormone (GnRH) antagonists, including relugolix, elagolix, and linzagolix, \nare highly effective in treating pain associated with endometriosis. Relugolix —particularly in combination with estradiol and \nnorethisterone acetate —significantly improved both dysmenorrhea and non -menstrual pelvic pain compared with placebo and \ndemonstrated a remarkable safety profile. Linzagolix produced significant dose -dependent pain reduction while also reducing side \neffects associated with hypoestrogenism (e.g., bone mineral density loss and vasomotor symptoms). Elagolix alleviated pain sy mptoms \nand improved work performance and daily functioning. Post -hoc analyses showed that elagolix reduced absenteeism and \npresenteeism, thereby improving work performance and suggesting significant socioeconomic benefits associated with symptom \ncontrol. Overall, current evidence suggests that GnRH antagonists play an important role in the pharmacological treatment of \nendometriosis.  \nGnRH antagonists offer a rapid onset of action, oral administration, dose -dependent hormone suppression, and improved \ntolerability. Prescribing these medications aligns with the principles of patient -centered medicine, allowing treatment to be tailored to \nindividual patient characteristics, symptom severity, and reproductive goals. They help improve the quality of life and occup ational \nfunction. Treatment with these medications can improve daily functioning and quality of life, including long -term disease control, and \nreduce the clinical and social consequences of endometriosis. \n \nAcknowledgments \nThere are no acknowledgments to disclose. \n \nAuthors’ Contributions \nKatarzyna Markuszka - contributed to the study conception and design, conducted the literature search and data analysis, wrote the \nmanuscript, and approved the final version for publication. \nZuzanna Irzyk - conducted the literature search and data analysis. \nEmilia Goc - conducted the literature search and data analysis. \nMateusz Szabat- conducted the literature search and data analysis. \nKlaudia Samuła - conducted the literature search and data analysis. \nDominika Ruszel - conducted the literature search and data analysis. \nJulia Rogała - conducted the literature search and data analysis. \nKinga Polityńska - conducted the literature search and data analysis. \nMartyna Sarzyńska - conducted the literature search and data analysis. \nSylwia Lepak - conducted the literature search and data analysis.  \n\n \nREVIEW | OPEN ACCESS   \n \nMedical Science 30, e114ms3857 (2026)                                                                                                                                                                    7 of 8 \n \nInformed consent \nNot applicable. \n \nEthical approval \nNot applicable. This article does not contain any studies with human participants or animals performed by any of the authors. \n \nFunding \nThis research did not receive any external funding like specific grant from funding agencies in the public, commercial, or nonprofit \nsectors. \n \nConflict of interest \nThe authors declare that they have no conflicts of interest, competing financial interests or personal relationships that could have \ninfluenced the work reported in this paper. \n \nData and materials availability \nAll data associated with this study will be available based on the reasonable request to corresponding author. \n \nREFERENCES \n1. Abulughod N, Valakas S, El-Assaad F. Dietary and nutritional \ninterventions for the management of endometriosis. Nutrients \n2024;16(23):3988. doi:10.3390/nu16233988. \n2. Chapron C, Marcellin L, Borghese B, Santulli P. Rethinking \nmechanisms and management of endometriosis. 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