THERAPEUTIC OPTIONS IN ENDOMETRIOSIS: A COMPARATIVE LITERATURE REVIEW OF INTRAUTERINE DEVICE THERAPY, SURGICAL TREATMENT, RELUGOLIX COMBINATION THERAPY, AND DIENOGEST

THERAPEUTIC OPTIONS IN ENDOMETRIOSIS: A COMPARATIVE LITERATURE REVIEW OF INTRAUTERINE DEVICE THERAPY, SURGICAL TREATMENT, RELUGOLIX COMBINATION THERAPY, AND DIENOGEST DOI: https://doi.org/10.31435/ijitss.1(49).2026.4910Keywords: Endometriosis, Chronic Pelvic Pain, Hormonal Treatment, Levonorgestrel-Releasing Intrauterine System, Relugolix, DienogestAbstract Endometriosis is a chronic, estrogen-dependent disease affecting women of reproductive age, associated with chronic pelvic pain, impaired fertility, and significant impairment of quality of life. The heterogeneous clinical presentation, variable disease severity, and high recurrence rates make therapeutic decision-making particularly challenging. This review summarizes and critically compares current evidence regarding four commonly used treatment modalities: the levonorgestrel-releasing intrauterine system (LNG-IUS), relugolix combination therapy, surgical intervention, and dienogest. The analysis focuses on their effectiveness in symptom reduction, safety profile, and suitability for long-term management. A review of randomized controlled trials and meta-analyses demonstrates that all reviewed modalities provide meaningful pain relief, though clinical applicability differs substantially. Surgical treatment, particularly laparoscopic excision, offers rapid symptom improvement, especially in deep infiltrating endometriosis, but is limited by invasiveness and recurrence risk. Dienogest and levonorgestrel-releasing intrauterine system represent minimally invasive hormonal options with sustained analgesic efficacy and favorable safety profiles, making them valuable for long-term disease control and postoperative maintenance. Relugolix combination therapy has emerged as a potent oral treatment for severe symptoms with acceptable long-term safety when combined with add-back therapy, although cost and monitoring requirements may limit its use. 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Journal of minimally invasive gynecology, 27(7), 1503–1510. https://doi.org/10.1016/j.jmig.2020.05.007 Downloads Published Issue Section License Copyright (c) 2026 Katarzyna Ścibisz, Karolina Ollik, Kamil Harenza, Mateusz Taranowicz, Olga Kowalczyk, Dominika Zdobylak, Monika Kowalska, Anita Zięba, Michał Domin, Justyna Całka This work is licensed under a Creative Commons Attribution 4.0 International License. All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles. CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.