Endometriosis
Diagnosis usually made by laparoscopy.
Combined oral contraceptive (see Contraception section) OR norethisterone OR medroxyprogesterone.
10-15mg daily for 4-6 months or longer, to be started on day 5 of cycle; increased to 20-25mg daily if required, dose only increased if spotting occurs and reduced once bleeding has stopped.
10mg 3 times a day for 90 consecutive days, begin treatment on day 1 of cycle.
Where more than one option is clinically appropriate select the option with the lowest acquisition cost.
Dienogest is an alternative treatment option for endometriosis (vs COC/progestogens including LNG-IUD/GnRH-a).
Dienogest is an alternative post operative treatment in women who have undergone surgical excision of endometriosis to prevent disease recurrence.
2mg once daily. Can be started at any time in the cycle and should be taken continuously at the same time every day. All hormonal contraceptives should be stopped, and non-hormonal contraception (if appropriate) should be used. Suitable for long term use i.e. until symptom control or desire for fertility.
See prescribing notes on triptorelin duration.
As per specialist
As per specialist
Relugolix, estradiol, norethisterone acetate is an option in adult women of reproductive age for symptomatic treatment of moderate to severe endometriosis in women with a history of previous medical or surgical treatment for their endometriosis whose symptoms persist following first line medical treatment +/- surgical treatment.
1 tablet once daily, dose to be taken at around the same time each day, starting within 5 days of the onset of menstrual bleeding, consider discontinuing treatment when patient enters menopause.
Prescribing Notes:
- For combined oral contraceptives see the Contraception section.
- Symptoms, particularly pelvic pain and abnormal uterine bleeding, may be better controlled if the combined oral contraceptive is taken continuously for 90 days.
- Evidence is limited regarding duration of treatment of Triptorelin, specialist may recommend extended duration therpay (off-label) under ongoing specilaist supervision and monitoring.
- Patients should be advised to use non-hormonal barrier methods of contraception when triptorelin is prescribed.
- Side-effects of Gonadotrophin-releasing hormone (GnRH) analogues related to the inhibition of oestrogen production may be reduced by hormone replacement (e.g. with an oestrogen and a progestogen or with tibolone).
- For prescribing Gonadotrophin-releasing hormone (GnRH) analogue (any medicinal product that consists of or contains buserelin, gonadorelin, goserelin, leuprorelin acetate, nafarelin or triptorelin), please refer to Scottish Drug Tariff part 12 Schedule 2 ‘Drugs to be prescribed in certain circumstances under the NHS Pharmaceutical services’ for items that must be endorsed ‘SLS’.
History Notes
10/09/2025
Updated prescribing information, ERWG Aug 2025
27/02/2025
Addition of dienogest and update to triptorelin recommendations, ERFC Feb 25
06/02/2025
Updated prescribing information gonadorelin analogues, ERWG Jan 2025
18/05/2022
East Region Formulary content agreed.