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Elagolix for Endometriosis-Associated Pain: A Narrative Review and Indian Expert Consensus

Year: 2026

Type: review

Abstract: Endometriosis is a chronic, estrogen-dependent disorder that places a considerable physical, psychosocial, and economic burden on women of reproductive age in India.Diagnostic delays, variation in clinical presentation, and uncertainty regarding the optimal use of newer oral therapies continue to complicate routine care.Elagolix, an oral gonadotropin-releasing hormone (GnRH) receptor antagonist, has recently been approved in India for the treatment of moderate to severe endometriosis-associated pain; however, guidance tailored to Indian clinical practice has been lacking.To address this unmet need, an expert consensus was developed to provide practical recommendations for the evaluation and management of endometriosis, with a specific focus on the positioning of elagolix in women who are not actively pursuing fertility.A structured modified Delphi approach was used, beginning with statement development by a steering committee, followed by regional expert panel discussions across India and anonymous validation using a 5-point Likert scale.Consensus was obtained with at least 75% agreement among participating experts.Eleven consensus statements were finalized, addressing early recognition, diagnostic strategies, empirical medical treatment, and the appropriate selection, dosing, and monitoring of elagolix.The panel emphasized early diagnosis, skilled transvaginal ultrasonography as first-line imaging, and medical therapy as the foundation of pain management in non-fertility-seeking women.Elagolix was recognized as an effective oral option for selected patients, particularly those with inadequate response or intolerance to first-line hormonal therapies, when used with individualized risk-benefit assessment.These consensus recommendations aim to support informed, context-appropriate decision-making and optimize long-term medical management of endometriosis-associated pain in routine clinical practice.

Source: Cureus

DOI: 10.7759/cureus.119395