Abstract Background: Endometriosis affects approximately 10% of reproductive-age women and manifests as chronic pelvic pain, dysmenorrhea, dyspareunia, and infertility [1]. While ovarian endometrioma is frequently recognized, extra-ovarian forms such as peritoneal, deep infiltrating (DIE), and extra-pelvic endometriosis (e.g., umbilical or surgical scar lesions) represent clinically significant but often underdiagnosed variants [2,3].Objective: To evaluate the clinical effectiveness of elagolix in symptom control of both ovarian and extra-ovarian endometriosis.Methods: This prospective, hospital-based observational study included 80 women (20–45 years) with clinically, ultrasonographically, or laparoscopically confirmed endometriosis. Participants received elagolix 150 mg once daily for six months. Pain scores (NRS 0–10), ovarian cyst volume, and regression of extra-pelvic lesions were evaluated at baseline, 3 months, and 6 months.Results: Mean pain scores decreased from 8.1 ± 1.0 to 2.9 ± 1.3 (p < 0.001). Pain reduction occurred across all subtypes—ovarian (63.9%), peritoneal (60%), DIE (62%), umbilical (61%), and scar endometriosis (59%). Ovarian cyst volume decreased modestly (mean 18%). Umbilical and scar lesions showed regression of swelling and cyclic bleeding. Adverse effects were mild and self-limiting.Conclusion: Elagolix provides effective, well-tolerated symptom relief in both pelvic and extra-pelvic endometriosis, supporting its role as a non-surgical, individualized therapeutic option.