Morphological modulation of ovarian endometrioma with elagolix: a case report

Abstract

Ovarian endometrioma is a common manifestation of endometriosis, an estrogen-dependent inflammatory disorder associated with chronic pelvic pain and dysmenorrhea in women of reproductive age. Although surgical cystectomy is often effective, it may compromise ovarian reserve which is a significant concern, particularly in young women, highlighting the need for effective medical alternatives. We report a rare case of non-surgical management of a large ovarian endometrioma using the oral gonadotropin-releasing hormone (GnRH) antagonist, Elagolix. A 21-year-old unmarried woman presented with severe dysmenorrhea and lower abdominal pain, and ultrasonography revealed a right ovarian endometrioma. She was initiated treatment with Elagolix 150 mg once daily. The patient experienced significant symptomatic relief with marked reduction in pain scores and no notable hypoestrogenic adverse effects. Follow-up imaging at week 10 demonstrated morphological changes within the cyst suggestive of necrotic transformation and reduced endometrial cell viability indicating inhibition of disease progression. This case highlights the role of individualized, dose-dependent hormonal modulation with Elagolix as a non-surgical option for managing ovarian endometriomas, achieving both clinical and radiological improvement with fertility-preservation.