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Hormonal suppression remains a core strategy for chronic endometriosis-associated pain. Randomized and observational evidence supports progestins such as dienogest for reducing dysmenorrhea and pelvic pain while limiting estrogen-driven endometrial and ectopic-tissue activity. For gynecologists, medical treatment is particularly relevant when fertility is not an immediate priority or when surgery would carry meaningful ovarian or anatomic risk. Long-term adherence and side effects such as irregular bleeding, mood changes or headache need discussion. Medical suppression does not eradicate endometriotic lesions, so symptoms may recur after discontinuation. The treatment plan should therefore be aligned with reproductive goals, disease burden and tolerance of therapy.
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Hormonal suppression remains a core strategy for chronic endometriosis-associated pain. Randomized and observational evidence supports progestins such as dienogest for reducing dysmenorrhea and pelvic pain while limiting estrogen-driven endometrial and ectopic-tissue activity. For gynecologists, medical treatment is particularly relevant when fertility is not an immediate priority or when surgery would carry meaningful ovarian or anatomic risk. Long-term adherence and side effects such as irregular bleeding, mood changes or headache need discussion. Medical suppression does not eradicate endometriotic lesions, so symptoms may recur after discontinuation. The treatment plan should therefore be aligned with reproductive goals, disease burden and tolerance of therapy.
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