From the Guidelines
Treatment for endometriosis-related pain should prioritize hormonal therapies, such as combined hormonal contraceptives or progestins, as first-line options, due to their effectiveness in reducing pain and suppressing endometrial growth. When considering treatment options for endometriosis-related pain, it's essential to evaluate the efficacy and safety of various approaches. According to the American College of Obstetricians and Gynecologists (ACOG) recommendations 1, hormonal therapies, including oral contraceptives and progestins, have been shown to be effective in reducing pain. Some key points to consider when treating endometriosis-related pain include:
- Hormonal therapies, such as combined hormonal contraceptives or progestins, can reduce pain by suppressing endometrial growth 1.
- GnRH agonists, like leuprolide, may be prescribed for more severe cases, but their use should be limited to 6-24 months due to concerns about bone density loss 1.
- Surgical options, including laparoscopic excision or ablation of endometriotic lesions, can provide significant pain relief for many patients, but the recurrence of symptoms is common 1.
- Complementary approaches, such as pelvic floor physical therapy, acupuncture, and dietary modifications, may provide additional relief when combined with medical management. It's crucial to weigh the benefits and risks of each treatment option and consider the individual patient's needs and preferences when developing a treatment plan for endometriosis-related pain.
From the FDA Drug Label
INDICATIONS AND USES Adjunctive therapy and palliative treatment of inoperable, recurrent, and metastatic endometrial or renal carcinoma. The FDA drug label does not answer the question.
From the Research
Treatment Options for Endometriosis-Related Pain
- Medical treatments for endometriosis-related pain aim to inhibit ovulation, reduce serum oestradiol levels, and suppress uterine blood flows 2
- Available treatment options include:
- Oral contraceptives (OCs) and progestogens, which are low-cost drugs with a similar magnitude of effect in terms of pain relief 2
- Gonadotropin-releasing hormone (GnRH) agonists, which can only be used for a short duration due to associated side effects 3
- Nonsteroidal anti-inflammatory drugs (NSAIDs), which are commonly used as first-line treatment but have limited evidence of effectiveness 4, 5
- Oral GnRH antagonists, such as elagolix, relugolix, and linzagolix, which allow oral administration and induce dose-dependent reduction of estradiol levels 3
- Drug delivery systems, such as those based on chitosan and 2-hydroxy-5-nitrobenzaldehyde, which may improve the bioavailability of diclofenac sodium salt and represent a future treatment formula for endometriosis pain 6
Hormonal Therapies
- Oral GnRH antagonists, including elagolix, relugolix, and linzagolix, have been shown to be effective in reducing endometriosis-related pain 3
- Elagolix at a low dose of 150 mg once daily or a higher dose of 200 mg twice daily significantly increased the proportion of women achieving clinically meaningful decline of dysmenorrhea, noncyclic pelvic pain, and dyspareunia 3
- Relugolix at an oral dose of 40 mg/day results in improvement in different forms of endometriosis-related pelvic pain, with an efficacy and side effect profile similar to that of GnRH agonists 3
- Adding 1 mg of estradiol and 0.5 mg of norethindrone to 40 mg of relugolix (relugolix combination therapy) allows extension of treatment to 24 weeks with maintained efficacy and an improved side effect profile 3
Non-Hormonal Therapies
- NSAIDs, such as naproxen, have been studied for their effectiveness in managing endometriosis-related pain, but the evidence is limited and inconclusive 4, 5
- There is no evidence to show whether any individual NSAID is more effective than another in managing endometriosis-related pain 4, 5
- Women using NSAIDs should be aware of the possibility of unintended effects, such as side effects and interactions with other medications 4, 5