Abstract : Endometriosis is a chronic, estrogen-dependent inflammatory disease affecting approximately 10% of women of reproductive age and represents one of the leading causes of chronic pelvic pain and infertility worldwide. Despite its high prevalence, diagnosis is frequently delayed, and treatment outcomes remain suboptimal in a substantial proportion of patients. Conventional management strategies, including surgery and standard hormonal therapies, are often associated with symptom recurrence, adverse effects, and limited long-term efficacy. Advances in molecular biology and immunology have significantly improved the understanding of endometriosis pathophysiology, revealing its complex inflammatory, immunological, and neurogenic background. This growing knowledge has led to the development of targeted therapeutic approaches aimed at specific molecular and hormonal pathways involved in disease progression. Among these, oral gonadotropin-releasing hormone (GnRH) antagonists represent a major therapeutic breakthrough, offering effective symptom control with improved safety and tolerability compared with traditional treatment options. This narrative review summarizes current evidence regarding endometriosis pathogenesis and contemporary management strategies, with particular emphasis on oral GnRH antagonists. Mechanisms of action, clinical efficacy, safety considerations, fertility implications, and future therapeutic perspectives are discussed in the context of available evidence and current clinical practice.