Endometriosis: Progesterone-Only Treatment

Single-Yellow-Girl

If you are unable to take estrogen or if you do not respond to combination (estrogen and progestin) pills, your gynecologist may prescribe progestin-only treatments such as Norethindrone (Nor-QD®, Camila®) Norethindrone acetate (Aygestin®), or Medroxyprogesterone acetate (Depo–Provera®). These medicines stop your body from ovulating and your endometriosis from growing. Most girls will not have a period. Taking synthetic (man–made) progestin medication in this form is very similar to the natural progesterone that is made by your body during pregnancy.

Are there any reasons why I wouldn’t be able to take Progestin–only hormone therapy?

Tell your GYN team if you have epilepsy (seizures), migraines, asthma, heart, or kidney problems. You should not take any kind of progestin if you are pregnant; have cancer, unexplained vaginal bleeding or severe liver disease. You should also tell the team if you have diabetes, high blood pressure, high cholesterol or you have been diagnosed with depression in the past.

What are the side effects?

Most young women have little or no side effects while taking progestin–only medication. Possible side effects can include breakthrough bleeding or spotting, changes in weight, acne, breast enlargement, feeling bloated, headache/migraines, nausea or vomiting, mood changes, and possible decrease in bone density (thinning of the bones).

Hormone medications can affect people differently. Some girls will have very irregular bleeding while taking progesterone–only hormone therapy, especially during the first 6 months of treatment. Breakthrough bleeding is less common the longer you are on hormonal therapy.

How is Norethindrone acetate taken?

Norethindrone acetate (Aygestin®) is a pill that you swallow.

Starting Aygestin®: Take 1-2 (5mg) tablet at the same time every day as prescribed by your health care provider. At Boston Children’s Hospital, we currently recommend that you do not take more than 10 mg of Aygestin®/day. Of note, norethindrone acetate is a very strong progestin medication however it is NOT approved as a form of birth control. If you are sexually active and on this medication, you should utilize another method to prevent pregnancy such as condoms.

How is Nor–QD® or Camilla® taken?

This progestin–only medication is a form of birth control that comes in a pill pack like regular birth control pills. There are 28 active hormone pills in each pack.

How is Medroxyprogesterone acetate given?

Medroxyprogesterone acetate (Depo–Provera®) is an injection that is given in a muscle (in the buttocks, arm or thigh) every 3 months. The first shot is usually given within the first 5 days of your menstrual cycle (during your period). If you are sexually active, a routine urine pregnancy test will be done first. The next shot needs to be scheduled within 11–13 weeks.

In addition to being as effective as other hormone therapies that treat endometriosis, both medications protect against pregnancy but NOT sexually transmitted infections (STIs). Always use condoms if you are sexually active.