Pelvic pain is the main clinical manifestation associated with endometriosis, a disorder caused by endometrial tissues growing outside the uterus. Pain relievers, hormonal contraceptives, aromatase inhibitors, androgenic agents, and gonadotropin-releasing hormone (Gn-RH) agonists are currently used to manage endometriosis-associated pelvic pain. However, more-efficacious and more easily administered medical options remain a high unmet need. The launches of second-generation, orally administered Gn-RH antagonists will significantly expand the endometriosis therapeutic market by 2026.

Questions Answered:

  • Endometriosis usually affects women of reproductive age. How large are the diagnosed prevalent endometriosis populations in the United States and EU5 (France, Germany, Italy, Spain, and the United Kingdom)? What percentage of diagnosed endometriosis patients received drug treatment in 2016? How will the drug-treated rate change in 2026?
  • We expect that by 2024, three Gn-RH antagonists will be launched. What clinical role will second-generation, oral Gn-RH antagonist therapies play in the management of endometriosis? What are clinical advantages of Gn-RH antagonists compared with Gn-RH agonists?
  • AbbVie’s elagolix is the most advanced oral Gn-RH antagonist in development. How will elagolix be differentiated from other emerging Gn-RH antagonists—relugolix and OBE-2109 in the endometriosis therapeutic market?Which emerging Gn-RH antagonists will enjoy the greatest clinical and commercial success by 2026?

Scope:

Market covered: United States, France, Germany, Italy, Spain, and the United Kingdom.

Primary research: Six country-specific interviews with endometriosis specialists.

Epidemiology: Diagnosed and drug-treated prevalent cases.

Emerging therapies: Phase III/PR: 2; Phase II: 3; coverage of select preclinical and Phase I products.

Market forecast: Drug-level sales and patient share of key endometriosis therapies in 2026.  

Key companies:  AbbVie, Bayer, Myovant, ObsEva, Repros.

Key drugs: elagolix, relugolix, OBE-2109, leuprolide, telapristone, vilaprisan.

Table of contents

  • Endometriosis - Landscape & Forecast - Disease Landscape & Forecast
    • Executive Summary
      • Key Findings
        • Regional Sales of Key Therapies to Treat Endometriosis: 2026
        • Endometriosis SWOT Analysis
    • Commercial Outlook
      • Key Findings
        • Drivers and Constraints
          • What Factors Are Driving Sales in Endometriosis?
          • What Factors Are Constraining Sales in Endometriosis?
        • Gonadotropin-Releasing Hormone Antagonists: Specific Trends
        • Forecast
          • Sales of Key Therapies in Endometriosis
        • Etiology and Pathophysiology
          • Key Findings
            • Expert Insight
            • Disease Overview
          • Clinical Features of Endometriosis
            • Locations of Endometriosis
          • Etiology
            • Pathophysiology
              • Key Pathways and Drug Targets
                • Key Drug Targets for Endometriosis
            • Epidemiology Overview
              • Key Findings
                • Epidemiology Populations
                  • Disease Definition
                  • Methods
                  • Sources Used for Diagnosed Prevalent Cases of Endometriosis
                  • Number of Diagnosed Prevalent Cases of Endometriosis
                  • Disease Definition
                  • Methods
                  • Sources Used for Diagnosed Prevalent Cases of Endometriosis by ASRM Stages
                  • Number of Surgically Diagnosed Prevalent Cases by ASRM Stages
                  • Sources Used for Drug-Treated Prevalence of Endometriosis
                  • Number of Confirmed Diagnosed and Drug-Treated Prevalent Cases of Endometriosis in the Major Pharmaceutical Markets: 2016-2026 (thousands)
              • Current Treatment Overview
                • Key Findings
                  • Diagnosis
                    • Expert Insight: Diagnosis for Endometriosis
                    • Treatment Providers and Referral Patterns
                  • Treatment Goals
                    • Key End Points Used in Clinical Trials for Endometriosis
                  • Key Current Therapies
                    • Overview
                    • Mechanism of Action of Key Current Drug Classes Used for Endometriosis
                    • Current Treatments Used for Endometriosis
                    • Clinical Trial Outcomes for Gonadotropin-Releasing Hormone Agonists
                    • Advantages and Disadvantages of Gonadotropin-Releasing Hormone Agonists
                    • Expert Insight: Gonadotropin-Releasing Hormone Agonists
                    • Clinical Trial Outcomes for Contraceptives and Progestins
                    • Advantages and Disadvantages of Contraceptives and Progestins
                    • Advantages and Disadvantages of NSAIDs
                    • Clinical Trial Outcomes for Aromatase Inhibitors
                    • Advantages and Disadvantages of Aromatase Inhibitors
                    • Advantages and Disadvantages of Androgens
                  • Medical Practice
                    • Overview
                    • Country and/or Regional Endometriosis Treatment Guidelines
                    • Region-Specific Treatment
                    • Generalized Treatment Decision Tree for Endometriosis
                • Unmet Need Overview
                  • Key Findings
                    • Attainment of Unmet Needs
                      • Current Attainment of Unmet Needs in Endometriosis
                      • Future Attainment of Unmet Needs in Endometriosis
                      • Top Unmet Needs in Endometriosis: Current and Future Attainment
                      • Expert Insight: Unmet Needs in Endometriosis
                  • Emerging Therapies Overview
                    • Key Findings
                      • Expert Insight
                      • Pipeline Trends for Endometriosis
                    • Key Emerging Therapies
                      • Notable Developments Among Key Emerging Therapies for Endometriosis
                      • Key Emerging Therapies in Development for Endometriosis
                      • Estimated Launch Dates of Key Emerging Therapies for the Treatment of Endometriosis
                      • Expert Insight on Use of Gn-RH Antagonists in the Treatment of Endometriosis
                      • Expert Insight: Use of Gn-RH Antagonists
                      • Elagolix Profile
                      • Elagolix Clinical Development
                      • Key Ongoing Clinical Trials of Elagolix in the Treatment of Endometriosis
                      • Expert Insight on Use of Elagolix in the Treatment of Endometriosis
                      • Expert Insight: Elagolix
                      • Expectations for Launch and Sales Opportunity of Elagolix in Endometriosis
                      • Relugolix Profile
                      • Relugolix Clinical Development
                      • Key Ongoing Clinical Trials of Relugolix in the Treatment of Endometriosis
                      • Expectations for Launch and Sales Opportunity of Relugolix in Endometriosis
                      • OBE-2109 Profile
                      • OBE-2109 Clinical Development
                      • Key Ongoing Clinical Trials of OBE-2109 in the Treatment of Endometriosis
                      • Expectations for Launch and Sales Opportunity of OBE-2109 in Endometriosis
                      • Expert Insight on Use of SPRMs in the Treatment of Endometriosis
                      • Expert Insight: Use of SPRMs
                      • Telapristone Profile
                      • Expectations for Launch and Sales Opportunity of Telapristone in Endometriosis
                      • Expectations for Launch and Sales Opportunity of Vilaprisan in Endometriosis
                    • Early-Phase Pipeline Analysis
                      • Notable Developments in the Early-Phase Pipeline for Endometriosis
                      • Select Compounds in Early-Phase Development for Endometriosis
                    • Patient Registries
                      • Patient Registries for Endometriosis
                      • Prominent Endometriosis Patient Organizations
                  • Access & Reimbursement Overview
                    • Region-Specific Reimbursement Practices
                    • Methodology
                      • Bottom-Up Forecasting Overview
                        • Patient Populations
                        • Drug-Specific Assumptions
                      • Bottom-Up Forecast Assumptions
                        • General Sources of Data
                        • Drug-Treatment Rate Assumptions in Endometriosis
                        • Patient Share Assumptions in Endometriosis
                        • General Statements About Pricing
                        • Sources for Drug Prices
                        • 2016 Exchange Rates
                        • Dosing, Days of Therapy, and Compliance
                        • Out-Year Forecasting
                        • Emerging Therapy Prices
                        • Price per Treated Day: 2026
                      • Primary Market Research
                        • Experts Interviewed
                    • Appendix
                      • Key Abbreviations Related to Endometriosis
                      • Brands, Marketers, and Generic Availability of Key Therapies for Endometriosis, by Market
                      • Endometriosis Bibliography

                  Author(s): Jing Wu

                  Jing is a Principal business insights analyst in the infectious, niche, and rare diseases team at Decision Resources Group, focusing on a diverse set of key niche and rare diseases.

                  Jing completed her M.B.A. at Boston University with concentrations in health sector management and finance. She also holds an M.S. in biomedical science from the University of Massachusetts Medical School and a B.S. in biochemistry from Nanjing University in China. She worked as a research assistant at the Molecular Cardiology Research Institute of Tufts Medical Center, where she was involved in several projects to identify genetic regulators contributing to heart diseases.