Elagolix as a Diagnostic and Therapeutic Bridge to Surgery in Refractory Progestogen Hypersensitivity

Progestogen hypersensitivity (PH) is a rare and underrecognized condition characterized by cyclical allergic reactions to endogenous or exogenous progestogens. We present a 27-year-old woman with an 11-year history of recurrent luteal-phase urticaria, angioedema, and anaphylaxis refractory to antihistamines, corticosteroids, and hormonal suppression. She was diagnosed with PH at age 21. Introduction of elagolix, a GnRH antagonist, led to marked symptomatic improvement by suppressing ovarian hormone production. Due to cost and side effects, definitive surgical management with total laparoscopic hysterectomy and bilateral salpingo-oophorectomy was performed, resulting in complete remission. Fewer than 200 cases are reported in the literature, and standardized diagnostic or treatment protocols are lacking. This case highlights the diagnostic complexity of PH, the therapeutic potential of GnRH antagonists as a bridge to surgery, and the importance of a multidisciplinary approach. It underscores the need for greater awareness, standardized diagnostic criteria, and further research into the immunologic mechanisms underlying PH to guide future management strategies.