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Hormonal treatment options include: Combined oral contraceptives : Continuous or cyclic regimens can reduce menstrual flow and suppress endometrial tissue activity Progestins : Available as oral medications, injections (depot medroxyprogesterone acetate), intrauterine devices (levonorgestrel-releasing IUD), or implants GnRH agonists : These medications induce a temporary menopausal state, effectively suppressing endometriosis but requiring add-back hormone therapy to minimize bone loss and vasomotor symptoms [21] [20] GnRH antagonists : FDA-approved oral options include elagolix (Orilissa) and relugolix/estradiol/norethindrone (Myfembree) with specific duration limits based on dosing and bone health considerations [18] [19] Aromatase inhibitors : Sometimes used in refractory cases, though not FDA-approved for this indication [23] [24] Bone mineral density monitoring is recommended for patients on long-term GnRH agonists or antagonists, particularly at higher doses or extended durations

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