A 28-year-old woman with surgically confirmed stage III endometriosis (revised ASRM) has dysmenorrhea and dyspareunia. She has completed childbearing plans for 2 years. The MOST appropriate medical treatment to suppress endometriosis pain long-term is:
- A Levonorgestrel-IUS (Mirena) or combined oral contraceptive pill ✓
- B NSAIDs alone on a regular basis
- C GnRH agonist depot for 12 months without add-back therapy
- D High-dose progestogen (medroxyprogesterone acetate 150 mg IM monthly)
Explanation
ESHRE and NICE guidelines recommend hormonal suppression as first-line for endometriosis-associated pain. Combined oral contraceptives (COC) or progestogen-only therapy (including LNG-IUS) are the preferred long-term options due to good efficacy, tolerability, and safety for extended use. GnRH agonists are effective but bone loss limits use to 6 months without add-back; they are not preferred for primary long-term management when no immediate pregnancy is planned. High-dose IM MPA causes prolonged amenorrhea and delayed fertility return, not preferred. COC/LNG-IUS offer reversibility and maintenance therapy.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.