The role of pharmacotherapy in the treatment of endometriosis: an update

Marisa Imbroane; Parker L. Bussies; Parker Bussies; Candice L Schachter; Cara Schachter; Lexi Frankel; Allison Bosch; Julia Santarosa; T. Falcone; Tommaso Falcone; Elliott G Richards

doi:10.1080/14656566.2025.2597272

The role of pharmacotherapy in the treatment of endometriosis: an update

Marisa Imbroane, Parker L. Bussies, Parker Bussies, Candice L Schachter, Cara Schachter, Lexi Frankel, Allison Bosch, Julia Santarosa, T. Falcone, Tommaso Falcone, Elliott G Richards

Expert opinion on pharmacotherapy · 2025 · vol. 26(17) , pp. 1877–1893 · doi:10.1080/14656566.2025.2597272 · PMID:41328046 · W4416901916

review OA: green CC0

View on OpenAlex View on PubMed View at publisher

⚙ AI-generated summary by claude@2026-06, 2026-06-06 ⓘ

This review synthesizes current evidence-based pharmacotherapy for endometriosis, focusing on updated guidelines and post-2020 literature, and explores emerging nonhormonal and precision medicine strategies.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

Abstract

INTRODUCTION: Endometriosis 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. AREAS COVERED: This 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. EXPERT OPINION: Hormonal 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.

My notes (saved in your browser only)

Condition tags

mesh:D004715endometriosisinfertility

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (100)

Source provenance

europepmc: last seen: 2026-06-04T01:30:01.192114+00:00
openalex: last seen: 2026-06-04T00:00:01.174412+00:00
pubmed: last seen: 2026-06-03T07:24:15.494259+00:00
unpaywall: last seen: 2026-06-02T02:00:03.124865+00:00

License: CC0 · commercial use OK

[1] A danazol-loaded intrauterine device decreases dysmenorrhea, pelvic pain, and dyspareunia associated with endometriosis via openalex

[2] A dose‐ranging study to determine the efficacy and safety of 1, 2, and 4 mg of dienogest daily for endometriosis via openalex

[3] Advantages of the association of resveratrol with oral contraceptives for management of endometriosis-related pain via openalex

[4] A gonadotropin-releasing hormone agonist versus a low-dose oral contraceptive for pelvic pain associated with endometriosis via openalex

[5] A Humanized Anti-Interleukin 6 Receptor Monoclonal Antibody, Tocilizumab, for the Treatment of Endometriosis in a Rat Model via openalex

[6] Analysis of the levonorgestrel-releasing intrauterine system in women with endometriosis via openalex

[7] An assessment of the efficacy and safety of dydrogesterone in women with ovarian endometrioma: An open‐label multicenter clinical study via openalex

[8] Angiogenesis signaling in endometriosis: Molecules, diagnosis and treatment (Review) via openalex

[9] A randomized trial assessing the efficacy of Silymarin on endometrioma-related manifestations via openalex

[10] Aromatase inhibitors in post-menopausal endometriosis via openalex

[11] Aromatase inhibitors in the treatment of endometriosis via openalex

[12] Assessment of Quality of Life, Sexual Quality of Life, and Pain Symptoms in Deep Infiltrating Endometriosis Patients with or Without Associated Adenomyosis and the Influence of a Flexible Extended Combined Oral Contraceptive Regimen: Results of a Prospective, Observational Study via openalex

[13] A Systematic Review of Systematic Reviews on the Use of Aromatase Inhibitors for the Treatment of Endometriosis: The Evidence to Date via openalex

[14] A systematic review on endometriosis during pregnancy: diagnosis, misdiagnosis, complications and outcomes via openalex

[15] Clinical and sonographic impact of oral contraception in patients with deep endometriosis and adenomyosis at 2 years of follow-up via openalex

[16] Clinical Management of Endometriosis via openalex

[17] Clinical use of artificial intelligence in endometriosis: a scoping review via openalex

[18] Combined Oral Contraceptive Therapy in Women with Posterior Deep Infiltrating Endometriosis via openalex

[19] Comparison of Yuzpe regimen, danazol, and mifepristone (RU486) in oral postcoital contraception. via openalex

[20] Continuous versus cyclic oral contraceptives after laparoscopic excision of ovarian endometriomas: a systematic review and metaanalysis via openalex

[21] Continuous versus cyclic oral contraceptives for the treatment of endometriosis: a systematic review via openalex

[22] Continuous versus cyclic use of oral contraceptives after surgery for symptomatic endometriosis: a prospective cohort study via openalex

[23] Deep endometriosis: definition, diagnosis, and treatment via openalex

[24] Deep endometriosis demystified: Natural progression, hormonal treatment, and malignant transformation via openalex

[25] Determinant factors of postoperative recurrence of endometriosis: difference between endometrioma and pain via openalex

[26] Dienogest and the Risk of Endometriosis Recurrence Following Surgery: A Systematic Review and Meta-analysis via openalex

[27] Dienogest in long-term treatment of endometriosis via openalex

[28] Dienogest vs GnRH agonists as postoperative therapy after laparoscopic eradication of deep infiltrating endometriosis with bowel and parametrial surgery: a randomized controlled trial via openalex

[29] Effect of Postoperative Hormonal Suppression on Fertility in Patients With Endometriosis After Conservative Surgery via openalex

[30] Effect of surgery on ovarian reserve in women with endometriomas, endometriosis and controls via openalex

[31] Effects of 3 month therapy with danazol after laparoscopic surgery for stage III/IV endometriosis: a randomized study via openalex

[32] Effects of silymarin, cabergoline and letrozole on rat model of endometriosis via openalex

[33] Efficacy and safety of different subsequent therapies after fertility preserving surgery for endometriosis: A systematic review and network meta-analysis via openalex

[34] Efficacy of exercise on pelvic pain and posture associated with endometriosis: within subject design via openalex

[35] Efficacy of hormone pre‐treatment before ART to improve reproductive outcomes in infertile women with endometriosis: Network meta‐analysis of randomized controlled trials via openalex

[36] Efficacy of N-Acetylcysteine on Endometriosis-Related Pain, Size Reduction of Ovarian Endometriomas, and Fertility Outcomes via openalex

[37] Efficacy of vaginal danazol treatment in women with recurrent deeply infiltrating endometriosis via openalex

[38] Endometriosis via openalex

[39] Endometriosis via openalex

[40] Endometriosis and Adverse Pregnancy Outcomes: A Nationwide Population-Based Study via openalex

[41] Endometriosis and infertility via openalex

[42] Endometriosis and infertility: a committee opinion via openalex

[43] Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review via openalex

[44] Endometriosis and menopause—management strategies based on clinical scenarios via openalex

[45] Endometriosis-associated pain scores and biomarkers in users of the etonogestrel-releasing subdermal implant or the 52-mg levonorgestrel-releasing intrauterine system for up to 24 months via openalex

[46] Endometriosis recurrence following post-operative hormonal suppression: a systematic review and meta-analysis via openalex

[47] EPIDEMIOLOGY OF ENDOMETRIOSIS via openalex

[48] Estrogen-progestins and progestins for the management of endometriosis via openalex

[49] Ethinylestradiol 20 μg/drospirenone 3 mg in a flexible extended regimen for the management of endometriosis-associated pelvic pain: a randomized controlled trial via openalex

[50] Genome-wide genetic analyses highlight mitogen-activated protein kinase (MAPK) signaling in the pathogenesis of endometriosis via openalex

[51] Genomics of Endometriosis: From Genome Wide Association Studies to Exome Sequencing via openalex

[52] Gonadotropin-releasing hormone agonist with add–back treatment is as effective and tolerable as dienogest in preventing pain recurrence after laparoscopic surgery for endometriosis via openalex

[53] High prevalence of endometriosis in infertile women with normal ovulation and normospermic partners via openalex

[54] Hormonal contraception in women with endometriosis: a systematic review via openalex

[55] Hospital-Associated Cost of Endometriosis in Canada: A Population-Based Study via openalex

[56] Impact of endometriosis on female fertility and the management options for endometriosis-related infertility in reproductive age women: a scoping review with recent evidences via openalex

[57] Impact of Pelvic Floor Physical Therapy on Function in Adolescents and Young Adults with Biopsy-Confirmed Endometriosis at a Tertiary Children's Hospital: A Case Series via openalex

[58] Introduction via openalex

[59] Kinase signalling pathways in endometriosis: potential targets for non-hormonal therapeutics via openalex

[60] Long acting progestogens versus combined oral contraceptive pill for preventing recurrence of endometriosis related pain: the PRE-EMPT pragmatic, parallel group, open label, randomised controlled trial via openalex

[61] Long-term cyclic and continuous oral contraceptive therapy and endometrioma recurrence: a randomized controlled trial via openalex

[62] Long-term hormonal treatment reduces repetitive surgery for endometriosis recurrence via openalex

[63] Long-term oral contraceptive pills and postoperative pain management after laparoscopic excision of ovarian endometrioma: a randomized controlled trial via openalex

[64] Long-term treatment of endometriosis with dienogest: retrospective analysis of efficacy and safety in clinical practice via openalex

[65] Low-dose danazol after combined surgical and medical therapy reduces the incidence of pelvic pain in women with moderate and severe endometriosis via openalex

[66] Low-dose oral contraceptive pill for dysmenorrhea associated with endometriosis: a placebo-controlled, double-blind, randomized trial via openalex

[67] Malignant transformation of residual endometriosis after hysterectomy: a case series via openalex

[68] MAP kinases and the inflammatory signaling cascade as targets for the treatment of endometriosis? via openalex

[69] Metformin as a Potential Treatment Option for Endometriosis via openalex

[70] N-acetylcysteine stimulates organelle malfunction in endometriotic cells via IFN-gamma signaling via openalex

[71] Natural therapies assessment for the treatment of endometriosis via openalex

[72] Oral and depot progestin therapy for endometriosis: towards a personalized medicine via openalex

[73] Oral GnRH Antagonists in Combination with Estradiol and Norethindrone Acetate for Pain Relief Associated with Endometriosis: A Review of Evidence of a Novel Class of Hormonal Agents via openalex

[74] Oral Gonadotropin-Releasing Hormone Antagonists in the Treatment of Endometriosis: Advances in Research via openalex

[75] Perioperative hormone treatment of endometriosis via openalex

[76] Placebo-controlled comparison of danazol and high-dose medroxypro-gesterone acetate in the treatment of endometriosis after conservative surgery via openalex

[77] Postmenopausal endometriosis via openalex

[78] Postoperative desogestrel for pelvic endometriosis-related pain: a randomized controlled trial via openalex

[79] Postoperative hormonal treatment for prevention of endometrioma recurrence after ovarian cystectomy: a systematic review and network meta‐analysis via openalex

[80] Postoperative Pain Is Driven by Preoperative Pain, Not by Endometriosis via openalex

[81] Predicting disease recurrence in patients with endometriosis: an observational study via openalex

[82] Pregnancy Outcomes in Women with Endometriosis via openalex

[83] Prostaglandins in Dysmenorrhoea and Endometriosis via openalex

[84] Recurrence after surgery for endometrioma: a systematic review and meta-analyses via openalex

[85] Recurrence and Pregnancy Rate After Surgery Treatment of Deep Infiltrating Endometriosis: A Systematic Review and Meta-analysis via openalex

[86] Recurrence of endometriosis in women with bilateral adnexectomy (with or without total hysterectomy) who received hormone replacement therapy via openalex

[87] Recurrence of endometriosis; risk factors, mechanisms and biomarkers; review of the literature via openalex

[88] Reduced pelvic pain in women with endometriosis: efficacy of long-term dienogest treatment via openalex

[89] Reevaluating response and failure of medical treatment of endometriosis: a systematic review via openalex

[90] Repurposing dichloroacetate for the treatment of women with endometriosis via openalex

[91] Resveratrol Inhibits Development of Experimental Endometriosis In Vivo and Reduces Endometrial Stromal Cell Invasiveness In Vitro1 via openalex

[92] Rethinking mechanisms, diagnosis and management of endometriosis via openalex

[93] Risk factors for recurrent endometriosis after conservative surgery in a quaternary care center in southern Thailand via openalex

[94] Role of ultrasonography in the diagnosis of endometriosis in infertile women: Ovarian endometrioma, deep endometriosis, and superficial endometriosis via openalex

[95] Single nucleotide polymorphisms of Interleukin − 4, Interleukin-18, FCRL3 and sPLA2IIa genes and their association in pathogenesis of endometriosis via openalex

[96] Surgery versus hormonal therapy for deep endometriosis: is it a choice of the physician? via openalex

[97] Surgical excision of endometriomas and ovarian reserve: a systematic review on serum antimüllerian hormone level modifications via openalex

[98] Surgical treatment of deep endometriosis: Impact on spontaneous conception via openalex

[99] Systematic review of patient-specific pre-operative predictors of pain improvement to endometriosis surgery via openalex

[100] The burden of endometriosis: costs and quality of life of women with endometriosis and treated in referral centres via openalex