Nonhormonal management of endometriosis: Role of dopamine D2 receptor agonists in preserving fertility and ovarian function

Rahi Tinni Basu, Pradip Kumar Mitra
In: F&S Reports · 2026 · vol. 7(5) , pp. 357–361 · doi:10.1016/j.xfre.2026.07.005 · W7170061276
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This paper discusses the role of dopamine D2 receptor agonists in the nonhormonal management of endometriosis, specifically focusing on their potential to preserve fertility and ovarian function.

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Abstract

Dopamine D2 receptor (DRD2) agonists represent a promising targeted, nonhormonal therapeutic strategy for endometriosis. These agents selectively downregulate vascular endothelial growth factor-A signaling, thereby inhibiting the aberrant angiogenesis that supports the survival and proliferation of endometriotic lesions. This review synthesizes preclinical and early clinical evidence on DRD2 targeting, with a focus on the clinical translation of cabergoline and quinagolide. In a randomized, double-blind, placebo-controlled pilot trial, a 6-month cabergoline regimen significantly reduced chronic pelvic pain scores and improved pain relief without serious adverse events. Additionally, post hoc analysis of lesion regression showed that 61.3% of lesions in the quinagolide group demonstrated regression, while ovulatory function was preserved in 93% of participants, consistent with maintenance of the hypothalamic–pituitary–ovarian axis. Collectively, these data suggest that DRD2 agonists may represent a fertility-compatible, mechanistically targeted therapeutic approach and underscore the need for adequately powered phase 3 clinical trials.

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