Endometriosis: Leuprolide Acetate With Add–Back

Share on FacebookTweet about this on TwitterEmail this to someonePrint this page

Single-Yellow-GirlLeuprolide acetate (Lupron Depot®) is a type of gonadotropin–releasing hormone agonist (GnRH agonist) medicine. GnRH agonist medications help to lower pelvic pain caused by endometriosis. Add–back therapy is the addition of a small amount of the hormones estrogen and progesterone or progesterone alone. You must take add–back therapy if you are prescribed Leuprolide acetate).

How does Leuprolide acetate work?

This medication works by shutting off hormones made by your ovaries, so your estrogen (one of the hormones that cause your body to have periods) level is lowered. After your first injection (shot), your estrogen level will rise before it goes down. This is called an “estrogen surge”. Because of this rise in estrogen, you may have an increase in your symptoms for a few weeks. After the estrogen surge, your estrogen levels will go down. This temporarily stops your period. When you do not have periods, endometriosis symptoms are usually relieved.

How is Leuprolide acetate given?

Leuprolide acetate is an injection. It is very important to get your injection on time. Missed doses can cause breakthrough bleeding and the return of pain.

How long can I take Leuprolide acetate with add–back ?

Leuprolide acetate alone is usually prescribed for 6 months (1 shot every 3 months). However, when you take it with add–back, you can almost always stay on it longer. After a few months of treatment you will have an appointment with your gynecologist to see if the medicine is helping you. This appointment also gives your doctor a chance to ask you about your pelvic pain and any other symptoms you may be having. If your symptoms are better, he may suggest that you continue taking the medicine.

What are the side effects of taking Leuprolide acetate?

Taking Leuprolide acetate alone lowers the estrogen level in the body, which typically causes side effects similar to menopause. These side effects may include: hot flashes, vaginal dryness, decreased interest in sex, moodiness, headaches, spotting, and change in bone density. However, with the addition of “add–back” therapy, you will most likely NOT experience these side effects. If you do have symptoms, they are generally mild.

After the second month of treatment, your period will likely stop. However, you may have a light period or spotting during treatment. It is important to get your injections on time and to stop treatment when recommended.

What is “Add–back” therapy?

Add–back is a pill that contains a small amount of estrogen and progesterone, or progesterone–only that is taken every day. Since hormones are important to keep your bones healthy, low levels of hormones can lower your bone density putting you at risk for osteoporosis (thinning of your bones). The goal of add–back therapy is to give your body back just enough hormone(s) to protect your bones and control any unwanted side effects such as hot flashes and vaginal dryness that are common when taking Leuprolide acetate alone. Your gynecologist will decide on how much add–back medicine you will need, and give you a prescription. Add–back is either: Aygestin® 5mg/daily, or Prempro® 0.625/2.5mg/daily.

When do the effects of Leuprolide acetate go away?

The effects of Leuprolide acetate will decrease after you stop taking the medicine. If you’ve been getting Lupron® every 3 months, your period will usually return within 4 to 8 months after your last shot. If you’ve been getting Lupron Depot® every month, your period will likely return 6–8 weeks after your last shot. Bone density loss may be partially or completely recovered. This means that your bones may or may not be as solid as they were before you started the medicine.

Can I take Leuprolide acetate forever?

Research has shown that long term use of Leuprolide acetate alone can cause bone density loss. Bone density loss is a big concern especially if you have a family history of osteoporosis. Osteoporosis causes your bones to become fragile and break more easily. “Add–back” therapy can help prevent loss of bone density, which may allow you to stay on the medicine longer.

What is bone density?

Bone density is a measurement of how solid and strong your bones are. Bones need to be strong and solid so they do not break easily. Your teenage and young adult years are important for bone development. Weak bones during the teenage years may negatively impact your bone health later in life. Your bones need lots of nutrients, especially calcium and vitamin D. It is also important to eat a well–balanced diet and include foods high in calcium.

When will I be scheduled for a bone density test?

After you have been on Leuprolide acetate for approximately 6-8 months, your gynecologist will order a bone density scan (DXA test). This is a simple test that measures how dense (or thick) your bones are and if your bones are thinning. If the DXA scan is normal and you continue on the medicine, you will need to repeat the DXA test every 1-2 years.

What can I do to prevent bone loss?

You will likely be told to take calcium and vitamin D supplements. Calcium works to build and maintain bone density. Vitamin D improves the absorption of calcium. Make sure to divide your daily dose of calcium if taking more than 500mg. Your body can only absorb so much at once.

Can I get pregnant when I am on Leuprolide acetate?

Although this medication works by preventing ovulation (stops you from making eggs), there is a rare chance that you could become pregnant if you have unprotected sex. Thus, it is important to use a non–hormonal birth control method such as condoms while on this medication. The long term effects to an unborn baby whose mother was on Leuprolide acetate at the time of conception are unknown at this time, but it does not appear to cause birth defects.

Remember, all medication affects people differently. If you have side effects, talk with your GYN team. It usually takes 2–3 menstrual cycles to see an improvement in symptoms and for your body to get used to the medicine. In the meantime, you can help your body feel better by eating well and getting plenty of rest and exercise.