Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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M.J. Solnik and M.T. Siedhoff
Table 12.2. Medical options for treating endometriosis-associated pain.
Medication Route of administration Notes
Combined oral contraceptives
(COCs)
Cyclic or continuous oral daily use Lack high-quality clinical trials
No agent seems to be more effective than another
Progestins Continuous oral daily use (Norethindrone acetate
5–20 mg daily; Medroxyprogesterone acetate
(5–100 mg daily))
Intramuscular depot form (150 mg IM q 3
months)
Intrauterine (levonorgestrel- intrauterine system;
LNGIUS)
Reduction in pain compared to placebo in clinical trials
Depot form no more effective with more side effects
Intrauterine administration effective even for DIE with fewer
side effects
Androgens Daily oral, vaginal or intrauterine Not all forms available in the US
Untoward androgenic side effects especially with oral forms
Gonadotropinreleasing
hormone
agonists
(GnRH-a)
Intramuscular depot (leuprolide acetate 3.75 mg
IM [1 month], 11.25 mg [3 month])
Reduction in pain compared to placebo in clinical trials
Comparable to COCs and progestins
Positive response in empiric trial
Hormonal add- back therapy required after 6 months of use to
minimize side effects (vasomotor symptoms, reduction in
bone mineral density); can be initiated immediately
Aromatase inhibitors
DIE Deeply invasive endometriosis
Daily oral use Limited data, but may be effective in reducing pain for DIE
Use with progestins or GnRH-a to prevent ovarian follicle
development