Comparison of Letrozole with Elagolix for the Management of Endometriosis-Associated Pain: A Quasi-Experimental Study

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OBJECTIVE: To compare the efficacy of Letrozole and Elagolix in the medical management of endometriosis-associated pain Study Design: A quasi-experimental study. Place and Duration of the Study: Department of Obstetrics and Gynaecology, Fatima Jinnah Medical University/Sir Ganga Ram Hospital, Lahore, Pakistan, from March to August 2025. METHODOLOGY: Women presenting with endometriosis-related pain were allocated to treatment groups. Patients in Group A (n = 29) received oral Letrozole 2.5 mg, while patients in Group B (n = 30) received oral Elagolix 150 mg once daily for three months. VAS pain scores were recorded before and 3 months post-intervention, and compared between the Letrozole and Elagolix groups using an independent samples t-test and chi-square test. RESULTS: Baseline data were comparable between the study groups (all p > 0.05). At 3 months post-intervention, the Elagolix group showed a significantly lower VAS score for dyspareunia (3.6 ± 2.2 vs. 4.7 ± 0.9; p = 0.016) and a greater reduction in dysmenorrhoea scores (2.2 ± 0.9 vs. 1.4 ± 1.8; p = 0.048). A shift from severe to mild was evident with significant improvements in pelvic pain (p = 0.043) and dysmenorrhoea (p = 0.036). Stratified analysis revealed significantly greater reductions in dysmenorrhea scores among Elagolix users aged ≤29 years (p = 0.025), with BMI <25 kg/m2 (p = 0.013) and regular menstrual cycles (p = 0.027). Pelvic pain scores also improved significantly in participants with a monthly household income of ≥ 50,000 PKR (p = 0.037). CONCLUSION: Elagolix demonstrated greater efficacy than Letrozole in reducing endometriosis-related pain after three months of treatment. This efficacy was more evident for dysmenorrhoea among specific patient subgroups, including those with younger age, lower BMI, or regular menstrual periods. KEY WORDS: Elagolix, Endometriosis, Letrozole, VAS pain.

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