Table 2.

Different therapies for the medical treatment of deep infiltrating endometriosis (DIE)

Therapy	Available forms	Advantages	Disadvantages
Progestogens and combined oral contraceptives (COCs)	Oral, intramuscular or subcutaneous injection, intrauterine devices, transdermal patches, vaginal rings	Effectively relieve DIE-associated symptomsLong-term safety Oral administration	Side effects: Abnormal uterine bleeding, nausea, breast tenderness, fluid retention, mood changes, risk of venous thromboembolismNeed for chronic administration due to rapid return of pain after treatment discontinuation
Gonadotropin-releasing hormone (GnRH) analogues	Most common administration route is intramuscular Oral administration: GnRHant (Elagolix)	Effective in the relief of DIE-associated symptoms Remarkable results when administered pre- or post-surgery, even on digestive symptoms	Require hormone add-back therapy due to adverse effects (menopausal symptoms, bone mineral density loss) Cannot be prolonged beyond six months because of the likelihood of hypoestrogenism? Early recurrence of symptoms after treatment suspension
Danazol	Most common administration route is vaginal	Effective in the relief of DIE-associated symptoms Well-tolerated	Side effects due to hyperandrogenism (acne, hirsutism)No contraceptive function
Aromatase inhibitors (AI)	Oral administration	Inhibits only local oestrogen production in endometriotic implantsPromising effect for managing severe endometriosis-associated pain Oral administration	Not yet approved for use in clinical practice for endometriosis Not effective if not associated with other drugs that inhibit ovulation