Expert opinion by Federation of Obstetric and Gynaecological Societies of India on elagolix − Redefining the endometriosis therapy landscape

BACKGROUND: Endometriosis is a substantial public health challenge, affecting nearly 10% of women of reproductive age. Given the therapeutic benefits of elagolix over conventional therapies, along with the growing body of clinical evidence, a comprehensive evaluation of its role in managing endometriosis is warranted. METHODS: An expert panel meeting was convened to deliberate on the clinical positioning of elagolix in the management of endometriosis-associated pain and to develop a comprehensive guideline on using elagolix in endometriosis. A literature search was conducted using the PubMed and Google Scholar databases to evaluate the efficacy and safety of elagolix in endometriosis-associated pain. RESULTS: In pivotal clinical trials, elagolix demonstrated a significant reduction in dysmenorrhoea and non-menstrual pelvic pain among women with endometriosis. Beyond pain relief, elagolix was associated with marked improvements in dyspareunia, fatigue and health-related quality of life. The safety profile of elagolix was favourable, with the most commonly reported adverse events being hot flushes, headache and nausea. When compared with current therapies, elagolix showed comparable efficacy with fewer hypo-oestrogenic side effects, such as bone mineral density loss, breakthrough bleeding and mood disturbances. CONCLUSION: Elagolix provides dose-dependent oestrogen suppression and significant pain relief in all types of endometriosis pain, including dyspareunia. Elagolix also provides notable improvements in quality of life with a more favourable safety profile compared to conventional therapies. These attributes position elagolix as an emerging first-line treatment option for the management of endometriosis-associated pain.