Oral Gonadotropin-Releasing Hormone Antagonists in the Management of Endometriosis-Associated Pain: A Comprehensive Review of Clinical Efficacy, Safety and Socioeconomic Impact

Endometriosis is a chronic, estrogen-dependent inflammatory disorder that affects approximately 10% of women of reproductive age, resulting in chronic pelvic pain and infertility. The principal clinical challenge is the management of endometriosis-associated pain (EAP), which substantially impairs quality of life and professional productivity. Conventional pharmacological treatments frequently provide inadequate relief or are constrained by significant adverse effects. Elagolix, relugolix, and linzagolix represent a newly developed class of oral non-peptide GnRH antagonists that have recently expanded the therapeutic landscape. Recent studies underscore the essential role of hormonal add-back therapy (ABT) in facilitating long-term management by preserving bone mineral density while suppressing pain. This review synthesizes current clinical data from major trials (ELARIS, SPIRIT, and SELECT) to evaluate the efficacy of these agents and examines their socio-technological impact, specifically how they reduce the socioeconomic burden of the disease and enhance patient autonomy and quality of life.