GnRH antagonists as a part of therapy for endometriosis and adenomyosis: a fresh approach to a long-standing problem

Aim: to review evolution of hormonal therapy for endometriosis with a particular focus on a role of GnRH antagonists in modern clinical practice. The paper will highlight mechanisms of action, efficacy and safety of these drugs, as well as their place in strategies for long-term treatment of endometriosis. Materials and Methods: a systematic analysis of scientific literature published in 2017–2024 was carried out. The relevant studies were searched using specific keywords ("endometriosis treatment", "GnRH antagonists", "Elagolix", "Relugolix", "Linzagolix", "hormonal therapy", "therapeutic window") in the PubMed, Scopus and Web of Science databases. Results: conventional approaches to hormonal therapy for endometriosis are associated with a number of limitations and adverse events. As the GnRH antagonists regulate serum estradiol level, this controls endometriosis symptoms effectively without a significant risk of osteoporosis. Among them, Elagolix, Relugolix and Linzagolix have shown clinical effectiveness. Conclusion: GnRH antagonists is a promising way to develop personalized medicine and to optimize therapeutic approaches for endometriosis and adenomyosis. Future studies should be focused on a comparative analysis of GnRH antagonists with estrogen-gestagen drugs and progestogens, with evidence of superiority of the former. Cost effectiveness and additional clinical significance of GnRH antagonists should be compared with conventional first-line therapeutic methods, as well as effectiveness of these drugs should be studied in patients with insufficient response to standard treatment. KEYWORDS: GnRH antagonists, endometriosis, adenomyosis. FOR CITATION: Ebert Andreas D. GnRH antagonists as a part of therapy for endometriosis and adenomyosis: a fresh approach to a long- standing problem. Russian Journal of Woman and Child Health. 2025;8(3):210–214 (in Russ.). DOI: 10.32364/2618-8430-2025-8-3-5