THERAPEUTIC OPTIONS IN ENDOMETRIOSIS: A COMPARATIVE LITERATURE REVIEW OF INTRAUTERINE DEVICE THERAPY, SURGICAL TREATMENT, RELUGOLIX COMBINATION THERAPY, AND DIENOGEST

Endometriosis is a chronic, estrogen-dependent disease affecting women of reproductive age, associated with chronic pelvic pain, impaired fertility, and significant impairment of quality of life. The heterogeneous clinical presentation, variable disease severity, and high recurrence rates make therapeutic decision-making particularly challenging. This review summarizes and critically compares current evidence regarding four commonly used treatment modalities: the levonorgestrel-releasing intrauterine system (LNG-IUS), relugolix combination therapy, surgical intervention, and dienogest. The analysis focuses on their effectiveness in symptom reduction, safety profile, and suitability for long-term management. A review of randomized controlled trials and meta-analyses demonstrates that all reviewed modalities provide meaningful pain relief, though clinical applicability differs substantially. Surgical treatment, particularly laparoscopic excision, offers rapid symptom improvement, especially in deep infiltrating endometriosis, but is limited by invasiveness and recurrence risk. Dienogest and levonorgestrel-releasing intrauterine system represent minimally invasive hormonal options with sustained analgesic efficacy and favorable safety profiles, making them valuable for long-term disease control and postoperative maintenance. Relugolix combination therapy has emerged as a potent oral treatment for severe symptoms with acceptable long-term safety when combined with add-back therapy, although cost and monitoring requirements may limit its use. No single therapeutic approach can be universally recommended for all patients. Optimal management requires an individualized strategy that balances efficacy, safety, and long-term tolerability. Minimally invasive hormonal therapies offer the most favorable balance for long-term management, while surgery and relugolix therapy remain essential options for selected or refractory cases.