The ESHRE PAIN II guideline on endometriosis recommends which approach as first-line medical treatment for pain in confirmed endometriosis?

• A GnRH agonist for 3–6 months as first-line
• B Dienogest 2 mg daily as first-line ahead of all other agents
• C Levonorgestrel-IUS as first-line for all endometriosis-associated pain
• D Combined hormonal contraceptive (CHC) or progestogen as first-line ✓

Explanation

The ESHRE 2022 endometriosis guidelines recommend combined hormonal contraceptives (oral, patch, ring) or progestogens as first-line medical therapy for endometriosis-associated pain, given their lower side-effect profile and cost compared to GnRH agonists/antagonists. GnRH agonists/antagonists are second-line or used when first-line therapy fails. Dienogest is an effective progestogen option but is not universally endorsed as superior to other progestogens as the single first-line agent. LNG-IUS is particularly effective for dysmenorrhea.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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