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The medical management of painful endometriosis is essentially based on anti-gonadotropic molecules and analgesics in the absence of a desire for pregnancy on the part of the patient, and constitutes the first therapeutic step. Dienogest, a new treatment, has found its place in the management algorithm for painful endometriosis due to its proven efficacy. It is recommended as a second-line treatment. The ANSM has very recently (March 2023) issued recommendations aimed at controlling the risk of meningioma for various progestogens including dienogest. Relugolix combination therapy, which combines a GnRH antagonist and an estrogen-progestin add-back therapy in a single tablet, appears to be a promising treatment for painful endometriosis, and the initial data on the safety of the treatment (after 6 months of use) are reassuring. Today, anti-aromatases, selective estrogen receptor modulators, or selective inhibitors cannot be considered as alternative therapies in the medical treatment of painful endometriosis.