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

Marisa Imbroane, Imbroane M, Parker L. Bussies, Bussies P, Parker Bussies, Candice L Schachter, Schachter C, Cara Schachter, Lexi Frankel, Frankel L, Allison Bosch, Bosch A, Julia Santarosa, Santarosa J, Tommaso Falcone, T. Falcone, Falcone T, Richards EG, Elliott G Richards
Expert opinion on pharmacotherapy · 2025 · vol. 26(17) , pp. 1877–1893 · doi:10.1080/14656566.2025.2597272 · PMID:41328046 · W4416901916
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⚙ 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.

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⚙ AI-generated deep summary by claude@2026-07, 2026-07-17 · read from full text ⓘ

This update review synthesizes evidence-based pharmacotherapy for endometriosis, integrating 2022 ESHRE recommendations and a PubMed literature search emphasizing articles published after 2020, covering a range of patient contexts and treatment stages. It reports that hormonal suppression remains central, with first-line options including NSAIDs, combined oral contraceptives, and progestins such as dienogest, while GnRH agonists/antagonists and aromatase inhibitors are positioned for refractory cases and add-back therapy is highlighted to reduce hypoestrogenic side effects. The paper also reviews postoperative regimens, fertility-preserving strategies, management in post-hysterectomy and postmenopausal populations, and investigational nonhormonal directions such as anti-inflammatory, antifibrotic, angiogenesis-modulating, and microbiome-targeting approaches, with the limitation inherent to a narrative update/review that it does not present new pooled primary trial results. This paper is centrally about endometriosis — it provides an updated, evidence-based review of pharmacologic treatment strategies and emerging therapies for the condition.

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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.
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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. Article highlights Since 2020, updated clinical guidelines and emerging pharmacologic data have reshaped endometriosis management strategies. First-line therapies – including NSAIDs, combined oral contraceptives, and progestins such as dienogest – remain central to symptom control. GnRH agonists/antagonists, aromatase inhibitors, and add-back therapy play key roles in refractory or long-term treatment. Novel therapeutic avenues include anti-inflammatory, antifibrotic, angiogenesis-modulating, and microbiome-targeting agents. Future management will emphasize precision medicine, nonhormonal options, and AI-assisted, fertility-focused, patient-tailored approaches. Declaration of interests The 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. Reviewer disclosures Peer reviewers on this manuscript have no relevant financial or other relationships to disclose. Supplementary material Supplemental data for this article can be accessed online at https://doi.org/10.1080/14656566.2025.2597272

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Condition tags

endometriosisinfertility

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)

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