Hormonal and Emerging Therapeutic Strategies in Endometriosis: Translating Pathophysiology into Targeted Treatment

Background/Objectives: Endometriosis is a chronic, estrogen-dependent inflammatory disease affecting approximately 10% of reproductive-age individuals and is associated with pelvic pain, infertility, and reduced quality of life. Despite its high prevalence, diagnosis is often delayed for years and current therapies primarily focus on hormonal suppression rather than disease modification. Recent work has clarified several biological pathways involved in endometriosis, including altered estrogen signaling, immune dysregulation, and neuroangiogenesis. These insights have prompted development of new diagnostic strategies and targeted therapies. This review aims to synthesize current evidence on advances in the diagnosis and treatment of endometriosis and to highlight emerging targeted therapies that may improve patient outcomes. Methods: A narrative review was carried out using PubMed, Scopus, and Web of Science, focusing on peer-reviewed work from the last two decades on endometriosis diagnosis and treatment. Clinical trials, systematic reviews, consensus recommendations, and observational studies were included to assemble a broad picture of established care and developing strategies. Results: Advances in diagnostic approaches include improvements in imaging modalities, development of candidate biomarkers, and exploration of non-invasive diagnostic tools aimed at reducing diagnostic delay. Therapeutic innovations include oral gonadotropin-releasing hormone (GnRH) antagonists, selective progesterone receptor modulators, aromatase inhibitors, and emerging immunomodulatory and anti-inflammatory treatments targeting key molecular pathways involved in disease progression. These developments reflect a shift toward more individualized and mechanism-based treatment strategies. Conclusions: Emerging diagnostic tools and targeted therapies represent promising advances in endometriosis care. Continued research integrating molecular insights with clinical practice may facilitate earlier diagnosis, improve symptom control, and support more personalized treatment approaches for individuals affected by endometriosis.