Introduction to hormonal treatment for endometriosis

Hormonal treatment can be started after a 3-month trial of analgesics, or at diagnosis, depending on the degree of bleeding and pain. Analgesia and hormone treatment can be used together.

Treatments include combined hormonal contraception (combined oral contraceptives [COCs] and the contraceptive vaginal ring) and progestogens (progestogen-only long-acting contraceptives or oral progestogens). No single option is known to be most effective; consider adverse effects and patient acceptability. Review response of hormone treatment after 3 months to assess adequacy of symptom relief and need for referral. Gonadotrophin-releasing hormone agonists and aromatase inhibitors may be prescribed by specialists.