Weighing up GnRH agonist therapy for endometriosis: outcomes and the treatment paradigm

Carneiro MM, Márcia Mendonça Carneiro
Expert opinion on pharmacotherapy · 2025 · vol. 26(4) , pp. 355–365 · doi:10.1080/14656566.2025.2459783 · PMID:39862122 · W4406824192
review OA: closed CC0
Full text JSON View on OpenAlex View on PubMed View at publisher
⚙ AI-generated summary by claude@2026-06, 2026-06-06 ⓘ

This review evaluated gonadotropin-releasing hormone agonists for endometriosis, finding they decrease pain and recurrence but have limiting side effects and costs.

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 estrogen-dependent disease affecting 10% of women worldwide leading to chronic pelvic pain and infertility which may be treated clinically or surgically. AREAS COVERED: Current literature was reviewed using the keywords 'gonadotropin releasing hormone agonists (GnRHa),' 'endometriosis,' 'infertility' and 'chronic pelvic pain.' Relevant papers prioritizing randomized controlled clinical trials (RCT), systematic reviews, meta-analyses, as well as international guidelines were evaluated. EXPERT OPINION: Available options for relieving endometriosis-associated pain include GnRHa, progestagens, and combined oral contraceptives, all of which block menstruation to control symptoms without curing the disease. GnRHa administration decreases pain and symptom recurrence after surgical treatment, but side effects and costs limit its use. Published studies to test its effectiveness in easing endometriosis-associated pain are heterogeneous, consider different outcomes with no long-term results. Drug choice should be individualized considering the side-effect profile, tolerability, costs, risks, and benefits as one size does not fit all. As we wait for the development of an ideal pharmacological agents, GnRHa with an add-back regimen remains a second-line option to alleviate the painful symptoms in women with endometriosis. Endometriosis management should consider the systemic nature of the disease and the complexity involved in the pathogenesis of symptoms.
Full text 3,800 characters · extracted from oa-doi-fallback · click to expand
ABSTRACT Introduction Endometriosis is a chronic inflammatory estrogen-dependent disease affecting 10% of women worldwide leading to chronic pelvic pain and infertility which may be treated clinically or surgically. Areas covered Current literature was reviewed using the keywords ‘gonadotropin releasing hormone agonists (GnRHa),’ ‘endometriosis,’ ‘infertility’ and ‘chronic pelvic pain.’ Relevant papers prioritizing randomized controlled clinical trials (RCT), systematic reviews, meta-analyses, as well as international guidelines were evaluated. Expert opinion Available options for relieving endometriosis-associated pain include GnRHa, progestagens, and combined oral contraceptives, all of which block menstruation to control symptoms without curing the disease. GnRHa administration decreases pain and symptom recurrence after surgical treatment, but side effects and costs limit its use. Published studies to test its effectiveness in easing endometriosis-associated pain are heterogeneous, consider different outcomes with no long-term results. Drug choice should be individualized considering the side-effect profile, tolerability, costs, risks, and benefits as one size does not fit all. As we wait for the development of an ideal pharmacological agents, GnRHa with an add-back regimen remains a second-line option to alleviate the painful symptoms in women with endometriosis. Endometriosis management should consider the systemic nature of the disease and the complexity involved in the pathogenesis of symptoms. Article highlights Endometriosis is a chronic inflammatory disease which should be regarded as a systemic disease that is not restricted to the pelvis. Various questions regarding endometriosis treatment remain and the research gap is huge as current therapies do not treat the disease itself but rather provide symptomatic relief with various side effects. The role of GnRHa in endometriosis has shifted tremendously over the years from first- to second-line option. Despite its efficacy in alleviating endometriosis painful symptoms, the use of GnRHa is limited by its side effects as well as costs. Studies in fact reveal that GnRHa use may result in no pain relief or persistence of pain in quite a few women. Available studies to test GnRHa ts effectiveness in easing endometriosis-associated pain are rather heterogeneous, consider different outcomes, and do not present long-term results. Prescribing an add-back therapy reduces the side-effect burden without interfering with GnRHa effectiveness in alleviating pain in women with endometriosis. Pre-treatment with GnRHa 3 to 6 months (ultra-long protocol) prior to in vitro fertilization (IVF) so as to improve success rates in terms of live birth rates is not recommended any more. A change in endometriosis management is mandatory as current treatments aim at treating pelvic lesions, fail to consider the systemic nature of the disease and the complexity involved in the pathogenesis of painful symptoms and infertility. Therefore, future studies should focus on understanding endometriosis biology so that individualized treatment approaches may be developed rather than a symptomatic implant-oriented approach. Declaration of interest M M Carneiro declares she has received travel grants and lecture honoraria from Ferring, Organon, Novo Nordisk and J&J. The author has no other 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 apart from those disclosed. Reviewer disclosure A peer reviewer on this manuscript has received an honorarium from Expert Opinion on Pharmacotherapy for their review work, but have no other relevant financial relationships to disclose.

Text is read by the "Ask this paper" AI Q&A widget below. Extraction quality varies by source — PMC NXML preserves structure cleanly, OA-HTML may include some navigation residue, and OA-PDF can have broken hyphenation. The publisher copy (via DOI) is the canonical version.

My notes (saved in your browser only)

⚙ Ask this paper AI returns verbatim quotes from the full text · source: oa-doi-fallback ⓘ

Answers must be backed by verbatim quotes from this paper's full text. Hallucinated quotes are dropped automatically; if no verbatim passage answers the question, we say so. How this works

Condition tags

endometriosischronic_pelvic_paininfertility

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 (82)

Cited by (2)

Source provenance

europepmc
last seen: 2026-07-26T06:08:39.051465+00:00
openalex
last seen: 2026-06-10T17:14:06.276822+00:00
pubmed
last seen: 2026-07-26T06:05:30.754788+00:00
License: CC0 · commercial use OK