Endometriosis: Hormonal Treatment Overview

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Single-Yellow-GirlThere is no cure for endometriosis, and if it is untreated it will grow, causing pain and lowering your chances of being able to become pregnant in the future. This is why you need to take medication. Treatment is aimed at controlling pain and preventing the endometriosis from getting worse. This guide was created to help you understand the different choices of hormonal treatment for endometriosis, as well as the benefits and possible side effects that are most commonly reported.

How do I know if hormone treatment is right for me?

Most young women can take hormone medicine, however, if you have certain medical conditions (such as a history of blood clots, high blood pressure, certain kinds of heart disease, hepatitis, severe migraines, or if you smoke), hormonal therapy may not be an option for you. Be sure to tell your gynecologist if you have migraine headaches with loss of vision, flashing lights, numbness/tingling, or loss of speech. Also, it is very important to tell your GYN doctor if anyone in your family has ever had a blood clot or stroke.

How does hormonal treatment work?

Hormonal treatment works by temporarily turning off your ovaries so you don’t ovulate (make eggs). When you don’t ovulate, you don’t have regular periods. When you are prescribed hormonal treatment continuously, you will rarely have periods or not have them at all. Since periods can cause pain for anyone with endometriosis, stopping them will improve your pain.

Hormonal treatment with combined estrogen and progestin: Oral contraceptive pills (ocp’s): OCP’s contain the hormones estrogen and progesterone. The goal of the treatment is to stop your periods and pain. Teens with endometriosis will take them in a continuous fashion.

The vaginal ring: The vaginal ring is a small, thin, flexible rubber ring that fits inside the vagina. Once in place it releases a combination of estrogen and progestin (hormones). If you choose this method of hormonal treatment for your endo, you would insert the ring and leave it in place for 3 weeks. You would then take it out and replace it with a new one right away. (If you are sexually active, neither you nor your partner will be able to feel the ring when it is inserted properly.)

Benefits:

  • Combined estrogen and progestin hormonal therapy may decrease, and in some cases stop endo pain.
  • Most girls will only have 0–4 periods a year.
  • Some young women prefer using the vaginal ring or patch because they don’t need to remember to take it every day.

Possible side effects:

  • Spotting or breakthrough bleeding can last for a few days until your body gets used to the medicine, or as long as you are taking it.
  • Some girls may have heavier bleeding or a regular period.
  • Breast tenderness, mood swings, headaches, nausea, cramps, bloating, and/or weight gain.
  • There is some concern that the patch may release a higher dose of hormones than the pill, which can increase the risk of blood clots and/or stroke.
  • Some girls who use the hormone patch may have skin irritation where the patch is worn.
  • Some girls who use the vaginal ring may have vaginal irritation.
  • Some girls may not have relief from their endometriosis pain.

Progesterone-only hormonal treatment: Norethindrone acetate: Norethindrone acetate (Aygestin®) is a pill that contains only progesterone. It is a type of hormone medicine that is often prescribed for patients that cannot take estrogen. The dosage is 5–15mg per day, and can be individualized for each patient.

Medroxyprogesterone Acetate (Depo–Provera®): Medroxyprogesterone acetate is another type of medication that only contains the hormone progesterone. It is an injection that is given once every 3 months by the GYN nurse or your primary health care provider. Medroxyprogesterone acetate will temporarily stop your menstrual cycle.

Benefits:

  • Progesterone–only hormone therapy can be effective in treating symptoms of endometriosis.

Possible side effects:

  • Spotting or breakthrough bleeding can last for a few days until your body gets used to the medicine, or as long as you are taking it.
  • Bleeding or a regular period.
  • Breast tenderness, mood swings, nausea, bloating, weight gain, and/or hair thinning.
  • Bone density loss and increased risk of osteoporosis (thinning of your bones) when taken for a long time.
  • Some girls may not have relief from their endometriosis pain.

Hormonal treatment with GnRH agonists (gonadotropin releasing hormone agonists) and  add–back: The combination of GnRH agonists and hormonal add–back therapy is usually prescribed when other hormonal medicine does not work in relieving endo pain. The goal of GnRH agonists and add–back therapy is to stop the endometriosis from growing and lowering the side effects of GnRH therapy alone. Add–back therapy is a small amount of progesterone, or a combination of estrogen and progesterone.

GnRH agonists work by temporarily turning off your pituitary gland, which stops your ovaries from making estrogen and progesterone (so you won’t have a period). Since all of the GnRH agonists lower estrogen levels, the possible side effects for all of the medicines in this group are the same symptoms that women often have during menopause. However, the add–back therapy that your gynecologist also prescribed will help reduce the side effects.

Leuprolide Acetate (Lupron–Depot®): Leuprolide acetate is one type of GnRH agonist that is given as an intramuscular (in the muscle) injection (shot). It can be given either once a month or once every 3 months. Our GYN team prefers that you get the injection once every 3 months so you don’t have to come in for appointments every month. Please make sure that the shot comes in the 3 month form (blue box).

Nafarelin Acetate: Nafarelin acetate (Synarel®) is another type of GnRH agonist that comes in the form of a nasal spray. The recommended dose is one puff in one nostril in the morning, then another puff in the other nostril at nighttime.

Benefits:

  • Low levels of estrogen cause your period to stop and endometriosis from growing.
  • Low levels of estrogen stop endo from growing so your fertility is preserved.

Possible side effects:

  • Bone density loss and higher risk of osteoporosis (thinning of your bones) when taken without add–back therapy.
  • Side effects may include hot flashes, mood swings, vaginal dryness, bone and joint aches, hair loss, lack of interest in sex, and possible short–term memory loss.
  • In many cases, teens and women may be able to stay on this treatment longer than six months as long as their bone density is checked and is normal.
  • Some girls may not have relief from their endometriosis pain.
Remember, all medicine affects each person differently. It usually takes about 2–3 months to see an improvement in symptoms and for your body to get used to any new medicine. Side effects will go away soon after the medication is stopped and your menstrual cycle returns. Deciding what treatment is best for you may take some time. Talk to your GYN team about any concerns or questions you might have. In the meantime, you can help your body feel better by eating well and getting plenty of exercise and rest.