Morphological modulation of ovarian endometrioma with elagolix: a case report

Manish Maladkar, Nayesh Patani, Chitra Tekchandani, Rachana Patil
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2026 · vol. 15(5) , pp. 1832–1836 · doi:10.18203/2320-1770.ijrcog20261297 · W7159572931
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

Elagolix, an oral GnRH antagonist, was used to treat a large ovarian endometrioma, resulting in symptomatic relief and morphological changes within the cyst suggestive of disease inhibition.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 ⓘ

This paper is a rare case report describing non-surgical treatment of a large right ovarian endometrioma in a 21-year-old woman with severe dysmenorrhea and lower abdominal pain, using the oral GnRH antagonist elagolix at 150 mg once daily. The patient reported marked reduction in pain scores without notable hypoestrogenic adverse effects, and follow-up ultrasonography at week 10 showed morphological changes within the cyst consistent with necrotic transformation and reduced endometrial cell viability. A key limitation is that findings are based on a single patient and observational imaging/clinical response without broader efficacy assessment or a controlled comparison. This paper is centrally about endometriosis — specifically, morphological modulation of an ovarian endometrioma with elagolix.

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Abstract

Ovarian endometrioma is a common manifestation of endometriosis, an estrogen-dependent inflammatory disorder associated with chronic pelvic pain and dysmenorrhea in women of reproductive age. Although surgical cystectomy is often effective, it may compromise ovarian reserve which is a significant concern, particularly in young women, highlighting the need for effective medical alternatives. We report a rare case of non-surgical management of a large ovarian endometrioma using the oral gonadotropin-releasing hormone (GnRH) antagonist, Elagolix. A 21-year-old unmarried woman presented with severe dysmenorrhea and lower abdominal pain, and ultrasonography revealed a right ovarian endometrioma. She was initiated treatment with Elagolix 150 mg once daily. The patient experienced significant symptomatic relief with marked reduction in pain scores and no notable hypoestrogenic adverse effects. Follow-up imaging at week 10 demonstrated morphological changes within the cyst suggestive of necrotic transformation and reduced endometrial cell viability indicating inhibition of disease progression. This case highlights the role of individualized, dose-dependent hormonal modulation with Elagolix as a non-surgical option for managing ovarian endometriomas, achieving both clinical and radiological improvement with fertility-preservation.

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Condition tags

endometriosisendometriomachronic_pelvic_paindysmenorrhea

Citation neighborhood

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