What are the current first-line pharmacological treatments for managing endometriosis-related pain?

First-line pharmacological treatments for managing pain associated with endometriosis include:

• A short trial (for example, 3 months) of paracetamol and/or a non-steroidal anti-inflammatory drug (NSAID) alone or in combination for initial pain management.
• Hormonal treatments such as combined oral contraceptive pills (COCs) or progestogens (including progestogen-only pills, implants, injectables, or the levonorgestrel intrauterine system) to reduce endometriosis-related pain.

Hormonal treatments should be offered to women with suspected, confirmed, or recurrent endometriosis who are not trying to conceive, as they can reduce pain and have no permanent negative effect on fertility.

If analgesics alone do not provide adequate pain relief, other pain management options and referral for further assessment should be considered.

Non-pharmacological management and specialist referral may also be appropriate depending on symptom severity and response to treatment.

References: NICE CKS, NICE NG73