Effectiveness of GnRH agonist (leuprolide acetate) after surgical treatment of endometriosis: A systematic review

Ath Thaariq Prasetiyo, Fatimah Usman, Faiza Khairunnisa, Zhafirah Afilia Putri, Nadhirah Sofhi Amanda, Muhammad Fadhil, Annisa Salsabillah, M. Irvan Ramadhan Putra, Arkan Abdullah Nashif
In: 10.35335/midwifery.v14i4 · 2026 · W7225071707
Systematic review / meta-analysis OA: diamond CC0
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This systematic review evaluated postoperative GnRH agonist therapy for endometriosis, finding that leuprolide acetate significantly reduced pelvic pain while evidence for preventing recurrence and improving reproductive outcomes remained limited and heterogeneous.

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Abstract

Endometriosis may recur after surgery despite removal of visible lesions. Postoperative hormonal suppression is therefore used to control residual disease and symptoms. Gonadotropin-releasing hormone (GnRH) agonists, including leuprolide acetate, provide ovarian suppression, but their benefits after surgery remain uncertain. This study aimed to evaluate the effectiveness of postoperative GnRH agonist therapy, particularly leuprolide acetate, in reducing pain and recurrence and improving reproductive outcomes after endometriosis surgery. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 framework and searched PubMed, Scopus, Cochrane Library, and ScienceDirect for studies published from 2020 to 2026. Among 312 identified records, 54 duplicates were removed and 258 records were screened. Forty-four full-text articles were assessed, of which 41 were excluded, leaving 3 publications for qualitative synthesis. These comprised one randomized controlled trial (n=20), one comparative clinical study (n=158), and one review of 10 randomized controlled trials. In the randomized trial, pelvic pain decreased in the leuprolide group from 4.6 ± 0.84 at baseline to 0.2 ± 0.42 at week 12 (p=0.003), with no significant difference compared with dienogest (p=1.000). The comparative study reported lower recurrence and higher pregnancy rates with leuprorelin than the comparator (both p0.05). Overall, evidence for pain was more supportive, whereas evidence for recurrence and reproductive outcomes remained limited and heterogeneous. Further randomized controlled trials are needed

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