The ESHRE 2022 revised guideline on endometriosis recommends empirical hormonal treatment without prior surgical diagnosis in women with suspicious symptoms. The first-line recommended agent is:

• A Gonadotrophin-releasing hormone agonist (GnRH-a) for 6 months
• B Dienogest 2 mg daily
• C Danazol 600 mg daily
• D Combined hormonal contraceptives (CHC) or progestogens ✓

Explanation

ESHRE 2022 guideline recommends that clinicians offer hormonal treatment empirically (without diagnostic laparoscopy) to women with symptoms suggestive of endometriosis. First-line agents are combined hormonal contraceptives (CHC) or progestogens (including oral progestogens, LNG-IUS) due to their favorable safety profile, cost, and evidence for symptom control. GnRH analogues are second-line due to hypoestrogenic side effects. Dienogest is a validated progestogen for endometriosis but is classified within the progestogen category. Danazol is largely obsolete due to androgenic side effects.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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