Clinical Guidance Paper VVOG: Pharmacological treatment of endometriosis-related pain

Richard P. Ellen; Ellen Remans; Celine Bafort; Céline Bafort; Celine Blank; Alex Bongima; Brecht Geysenbergh; Tjalina Hamerlynck; Geert Page; Jasper Verguts; Carla Tomassetti

doi:10.1016/j.eurox.2025.100403

Clinical Guidance Paper VVOG: Pharmacological treatment of endometriosis-related pain

Richard P. Ellen, Ellen Remans, Celine Bafort, Céline Bafort, Celine Blank, Alex Bongima, Brecht Geysenbergh, Tjalina Hamerlynck, Geert Page, Jasper Verguts, Carla Tomassetti

European journal of obstetrics & gynecology and reproductive biology: X · 2025 · vol. 27 , pp. 100403 · doi:10.1016/j.eurox.2025.100403 · PMID:40740165 · W4410894033

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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This clinical guidance paper provides recommendations for the pharmacological management of endometriosis-associated pain.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

Abstract

Gedeon Richter and Ferring Pharmaceuticals; Gedeon-Richter; Samsung

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Condition tags

endometriosis

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References (85)

70 Effects of relugolix combination therapy on endometriosis-associated pain and analgesic use in spirit studies: overall study and european populations via openalex
An international terminology for endometriosis, 2021, via openalex
An International Terminology for Endometriosis, 2021 via openalex
A Systematic Review of Systematic Reviews on the Use of Aromatase Inhibitors for the Treatment of Endometriosis: The Evidence to Date via openalex
A systematic review on the prevalence of endometriosis in women via openalex
Clinical efficacy of add-back therapy in treatment of endometriosis: a meta-analysis via openalex
Comparing the Effect of Dienogest and OCPS on Pain and Quality of Life in Women with Endometriosis: A Randomized, Double-Blind, Placebo-Controlled Trial via openalex
Complications, pregnancy and recurrence in a prospective series of 500 patients operated on by the shaving technique for deep rectovaginal endometriotic nodules via openalex
Continuous use of an oral contraceptive for endometriosis-associated recurrent dysmenorrhea that does not respond to a cyclic pill regimen via openalex
Continuous use of oral contraceptives: an overview of effects and side‐effects via openalex
Continuous versus cyclic oral contraceptives after laparoscopic excision of ovarian endometriomas: a systematic review and metaanalysis via openalex
Curative effect of 1.88‐mg and 3.75‐mg gonadotrophin‐releasing hormone agonist on stage III–IV endometriosis: Randomized controlled study via openalex
Dienogest and the Risk of Endometriosis Recurrence Following Surgery: A Systematic Review and Meta-analysis via openalex
Dienogest as a Maintenance Treatment for Endometriosis Following Surgery: A Systematic Review and Meta-Analysis via openalex
Dienogest in long-term treatment of endometriosis via openalex
Dienogest versus continuous oral levonorgestrel/EE in patients with endometriosis: what’s the best choice? via openalex
Dienogest vs GnRH agonists as postoperative therapy after laparoscopic eradication of deep infiltrating endometriosis with bowel and parametrial surgery: a randomized controlled trial via openalex
Effectiveness of Norethisterone Acetate alone Versus in Combination with Letrozole for treatment of Chronic Pelvic Chronic Pain and Dyspareunia in Patients with Endometriosis via openalex
Effective post-laparoscopic treatment of endometriosis with dydrogesterone via openalex
Effects of long-term postoperative dienogest use for treatment of endometriosis on bone mineral density via openalex
Efficacy and safety of oral gonadotropin-releasing hormone antagonists in moderate-to-severe endometriosis-associated pain: a systematic review and network meta-analysis via openalex
Efficacy of dienogest vs combined oral contraceptive on pain associated with endometriosis: Randomized clinical trial via openalex
Efficacy of levonorgestrel releasing intrauterine system as a postoperative maintenance therapy of endometriosis: A meta-analysis via openalex
Endometriosis-associated pain scores and biomarkers in users of the etonogestrel-releasing subdermal implant or the 52-mg levonorgestrel-releasing intrauterine system for up to 24 months via openalex
Endometriosis: diagnosis and management NICE guideline [NG73] via openalex
Endometriosis recurrence following post-operative hormonal suppression: a systematic review and meta-analysis via openalex
Gabapentin for chronic pelvic pain in women (GaPP2): a multicentre, randomised, double-blind, placebo-controlled trial via openalex
Gonadotrophin-Releasing Hormone Analogues for Pain Associated With Endometriosis via openalex
Gonadotropin-releasing hormone analogues for endometriosis via openalex
Hormonal contraception in women with endometriosis: a systematic review via openalex
Levonorgestrel-releasing intrauterine device (LNG-IUD) for symptomatic endometriosis following surgery via openalex
Levonorgestrel-releasing intrauterine system vs. systemic medication or blank control for women with dysmenorrhea: Systematic review and meta-analysis of randomized controlled trials via openalex
Long-term oral contraceptive pills and postoperative pain management after laparoscopic excision of ovarian endometrioma: a randomized controlled trial via openalex
LONG-TERM THERAPY OF ELAGOLIX + ADD-BACK THERAPY IN WOMEN WITH ENDOMETRIOSIS-ASSOCIATED PAIN FOR 48 MONTHS: A SAFETY UPDATE ON BONE MINERAL DENSITY DATA OF A PHASE 3 STUDY via openalex
Long-term treatment of endometriosis with dienogest: retrospective analysis of efficacy and safety in clinical practice via openalex
Naproxen sodium in dysmenorrhea secondary to endometriosis. via openalex
Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis via openalex
O-027 Efficacy results from a phase 3, randomized, placebo-controlled trial testing two doses of linzagolix in women with endometriosis-associated pain via openalex
Once daily oral relugolix combination therapy versus placebo in patients with endometriosis-associated pain: two replicate phase 3, randomised, double-blind, studies (SPIRIT 1 and 2) via openalex
Oral contraceptives and risk of endometriosis: a systematic review and meta-analysis via openalex
Oral contraceptives for pain associated with endometriosis via openalex
Post-operative endometriosis recurrence: a plea for prevention based on pathogenetic, epidemiological and clinical evidence via openalex
Postoperative hormonal treatment for prevention of endometrioma recurrence after ovarian cystectomy: a systematic review and network meta‐analysis via openalex
Postoperative oral contraceptive exposure and risk of endometrioma recurrence via openalex
Post-operative use of oral contraceptive pills for prevention of anatomical relapse or symptom-recurrence after conservative surgery for endometriosis via openalex
Pre- and postsurgical medical therapy for endometriosis surgery via openalex
Prevention of the recurrence of symptom and lesions after conservative surgery for endometriosis via openalex
Progestagens and anti-progestagens for pain associated with endometriosis via openalex
Progestins in the symptomatic management of endometriosis: a meta-analysis on their effectiveness and safety via openalex
Recurrence after surgery for endometrioma: a systematic review and meta-analyses via openalex
Recurrent endometriosis: a battle against an unknown enemy via openalex
Relugolix, an oral gonadotropin-releasing hormone receptor antagonist, reduces endometriosis-associated pain in a dose–response manner: a randomized, double-blind, placebo-controlled study via openalex
RELUGOLIX COMBINATION THERAPY IMPROVES MULTIPLE DIMENSIONS OF QUALITY OF LIFE IN WOMEN WITH ENDOMETRIOSIS-ASSOCIATED PAIN: RESULTS FROM THE SPIRIT PROGRAM via openalex
Sustained Efficacy and Safety of Relugolix Combination Therapy in Women with Endometriosis-Associated Pain: Spirit 52-Week Data via openalex
The Efficacy of Dienogest in Reducing Disease and Pain Recurrence After Endometriosis Surgery: a Systematic Review and Meta-Analysis via openalex
The use of progestin subdermal implants in the management of endometriosis-related pain symptoms and quality of life: a systematic review via openalex
Treatment of Endometriosis-Associated Pain with Elagolix, an Oral GnRH Antagonist via openalex
Treatment of endometriosis-associated pain with linzagolix, an oral gonadotropin-releasing hormone–antagonist: a randomized clinical trial via openalex
Two-year efficacy and safety of relugolix combination therapy in women with endometriosis-associated pain: SPIRIT open-label extension study via openalex
Use of combined hormonal contraceptives for the treatment of endometriosis-related pain: a systematic review of the evidence via openalex
W6846326326 via openalex
W6853195860 via openalex
W3134049157 via openalex
W2988425880 via openalex
W2987085499 via openalex
W2882660557 via openalex
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W4365920327 via openalex
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Source provenance

europepmc: last seen: 2026-06-04T01:30:01.192114+00:00
openalex: last seen: 2026-06-04T00:00:01.174412+00:00
pmc: last seen: 2026-05-13T20:22:03.195721+00:00
pubmed: last seen: 2026-06-04T00:31:15.822300+00:00

License: CC0 · commercial use OK

[1] 70 Effects of relugolix combination therapy on endometriosis-associated pain and analgesic use in spirit studies: overall study and european populations via openalex

[2] An international terminology for endometriosis, 2021, via openalex

[3] An International Terminology for Endometriosis, 2021 via openalex

[4] A Systematic Review of Systematic Reviews on the Use of Aromatase Inhibitors for the Treatment of Endometriosis: The Evidence to Date via openalex

[5] A systematic review on the prevalence of endometriosis in women via openalex

[6] Clinical efficacy of add-back therapy in treatment of endometriosis: a meta-analysis via openalex

[7] Comparing the Effect of Dienogest and OCPS on Pain and Quality of Life in Women with Endometriosis: A Randomized, Double-Blind, Placebo-Controlled Trial via openalex

[8] Complications, pregnancy and recurrence in a prospective series of 500 patients operated on by the shaving technique for deep rectovaginal endometriotic nodules via openalex

[9] Continuous use of an oral contraceptive for endometriosis-associated recurrent dysmenorrhea that does not respond to a cyclic pill regimen via openalex

[10] Continuous use of oral contraceptives: an overview of effects and side‐effects via openalex

[11] Continuous versus cyclic oral contraceptives after laparoscopic excision of ovarian endometriomas: a systematic review and metaanalysis via openalex

[12] Curative effect of 1.88‐mg and 3.75‐mg gonadotrophin‐releasing hormone agonist on stage III–IV endometriosis: Randomized controlled study via openalex

[13] Dienogest and the Risk of Endometriosis Recurrence Following Surgery: A Systematic Review and Meta-analysis via openalex

[14] Dienogest as a Maintenance Treatment for Endometriosis Following Surgery: A Systematic Review and Meta-Analysis via openalex

[15] Dienogest in long-term treatment of endometriosis via openalex

[16] Dienogest versus continuous oral levonorgestrel/EE in patients with endometriosis: what’s the best choice? via openalex

[17] Dienogest vs GnRH agonists as postoperative therapy after laparoscopic eradication of deep infiltrating endometriosis with bowel and parametrial surgery: a randomized controlled trial via openalex

[18] Effectiveness of Norethisterone Acetate alone Versus in Combination with Letrozole for treatment of Chronic Pelvic Chronic Pain and Dyspareunia in Patients with Endometriosis via openalex

[19] Effective post-laparoscopic treatment of endometriosis with dydrogesterone via openalex

[20] Effects of long-term postoperative dienogest use for treatment of endometriosis on bone mineral density via openalex

[21] Efficacy and safety of oral gonadotropin-releasing hormone antagonists in moderate-to-severe endometriosis-associated pain: a systematic review and network meta-analysis via openalex

[22] Efficacy of dienogest vs combined oral contraceptive on pain associated with endometriosis: Randomized clinical trial via openalex

[23] Efficacy of levonorgestrel releasing intrauterine system as a postoperative maintenance therapy of endometriosis: A meta-analysis via openalex

[24] Endometriosis-associated pain scores and biomarkers in users of the etonogestrel-releasing subdermal implant or the 52-mg levonorgestrel-releasing intrauterine system for up to 24 months via openalex

[25] Endometriosis: diagnosis and management NICE guideline [NG73] via openalex

[26] Endometriosis recurrence following post-operative hormonal suppression: a systematic review and meta-analysis via openalex

[27] Gabapentin for chronic pelvic pain in women (GaPP2): a multicentre, randomised, double-blind, placebo-controlled trial via openalex

[28] Gonadotrophin-Releasing Hormone Analogues for Pain Associated With Endometriosis via openalex

[29] Gonadotropin-releasing hormone analogues for endometriosis via openalex

[30] Hormonal contraception in women with endometriosis: a systematic review via openalex

[31] Levonorgestrel-releasing intrauterine device (LNG-IUD) for symptomatic endometriosis following surgery via openalex

[32] Levonorgestrel-releasing intrauterine system vs. systemic medication or blank control for women with dysmenorrhea: Systematic review and meta-analysis of randomized controlled trials via openalex

[33] Long-term oral contraceptive pills and postoperative pain management after laparoscopic excision of ovarian endometrioma: a randomized controlled trial via openalex

[34] LONG-TERM THERAPY OF ELAGOLIX + ADD-BACK THERAPY IN WOMEN WITH ENDOMETRIOSIS-ASSOCIATED PAIN FOR 48 MONTHS: A SAFETY UPDATE ON BONE MINERAL DENSITY DATA OF A PHASE 3 STUDY via openalex

[35] Long-term treatment of endometriosis with dienogest: retrospective analysis of efficacy and safety in clinical practice via openalex

[36] Naproxen sodium in dysmenorrhea secondary to endometriosis. via openalex

[37] Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis via openalex

[38] O-027 Efficacy results from a phase 3, randomized, placebo-controlled trial testing two doses of linzagolix in women with endometriosis-associated pain via openalex

[39] Once daily oral relugolix combination therapy versus placebo in patients with endometriosis-associated pain: two replicate phase 3, randomised, double-blind, studies (SPIRIT 1 and 2) via openalex

[40] Oral contraceptives and risk of endometriosis: a systematic review and meta-analysis via openalex

[41] Oral contraceptives for pain associated with endometriosis via openalex

[42] Post-operative endometriosis recurrence: a plea for prevention based on pathogenetic, epidemiological and clinical evidence via openalex

[43] Postoperative hormonal treatment for prevention of endometrioma recurrence after ovarian cystectomy: a systematic review and network meta‐analysis via openalex

[44] Postoperative oral contraceptive exposure and risk of endometrioma recurrence via openalex

[45] Post-operative use of oral contraceptive pills for prevention of anatomical relapse or symptom-recurrence after conservative surgery for endometriosis via openalex

[46] Pre- and postsurgical medical therapy for endometriosis surgery via openalex

[47] Prevention of the recurrence of symptom and lesions after conservative surgery for endometriosis via openalex

[48] Progestagens and anti-progestagens for pain associated with endometriosis via openalex

[49] Progestins in the symptomatic management of endometriosis: a meta-analysis on their effectiveness and safety via openalex

[50] Recurrence after surgery for endometrioma: a systematic review and meta-analyses via openalex

[51] Recurrent endometriosis: a battle against an unknown enemy via openalex

[52] Relugolix, an oral gonadotropin-releasing hormone receptor antagonist, reduces endometriosis-associated pain in a dose–response manner: a randomized, double-blind, placebo-controlled study via openalex

[53] RELUGOLIX COMBINATION THERAPY IMPROVES MULTIPLE DIMENSIONS OF QUALITY OF LIFE IN WOMEN WITH ENDOMETRIOSIS-ASSOCIATED PAIN: RESULTS FROM THE SPIRIT PROGRAM via openalex

[54] Sustained Efficacy and Safety of Relugolix Combination Therapy in Women with Endometriosis-Associated Pain: Spirit 52-Week Data via openalex

[55] The Efficacy of Dienogest in Reducing Disease and Pain Recurrence After Endometriosis Surgery: a Systematic Review and Meta-Analysis via openalex

[56] The use of progestin subdermal implants in the management of endometriosis-related pain symptoms and quality of life: a systematic review via openalex

[57] Treatment of Endometriosis-Associated Pain with Elagolix, an Oral GnRH Antagonist via openalex

[58] Treatment of endometriosis-associated pain with linzagolix, an oral gonadotropin-releasing hormone–antagonist: a randomized clinical trial via openalex

[59] Two-year efficacy and safety of relugolix combination therapy in women with endometriosis-associated pain: SPIRIT open-label extension study via openalex

[60] Use of combined hormonal contraceptives for the treatment of endometriosis-related pain: a systematic review of the evidence via openalex

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