Gonadotropin-releasing hormone agonists for endometriosis

A 36- year- old woman presents with long- standing pelvic pain, including dysmenorrhea and pain with intercourse. She has previously received oral contraceptives and depot medroxyprogesterone for presumed endometriosis. This regimen has not relieved her pain, and she has had side effects, including continual abnormal uterine bleeding and fluid retention. She is referred to a reproductive endocrinologist for further investigation and treatment. After a careful review and examination to rule out other explanations for the patient's symptoms, the endocrinologist recommends the use of a gonadotropin- releasing hormone agonist combined with norethindrone acetate as empirical treatment for endometriosis.