Leuprolide 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 progestin or progestin alone. Your child must take add–back therapy if they are prescribed leuprolide acetate.
How does leuprolide acetate work?
This medication works by shutting off hormones made by your child’s ovaries, so her estrogen (one of the hormones that causes their body to have periods) level is lowered. After their first injection, their estrogen level will rise before it goes down. This is called an “estrogen surge.” Because of this rise in estrogen, they may have an increase in their endo symptoms for a few days. After the estrogen surge, their estrogen levels will go down. This temporarily stops their period. Without periods endometriosis symptoms usually go away.
How is leuprolide acetate given?
Leuprolide acetate is an injection. It is very important that your child gets their injection on time. Missed doses can cause breakthrough bleeding and the return of pain.
How long can my child stay on leuprolide acetate with add–back?
Leuprolide acetate alone is usually prescribed for 6 months (1 injection every 3 months). However, when it is taken with add–back, a patient can almost always stay on it longer. After a few months of treatment your child will be scheduled for a follow–up appointment with their gynecologist to see if the medicine is helping them. This appointment also gives your child’s gynecologist a chance to ask them about their pelvic pain and any other symptoms they may be having. If their symptoms are better, their gynecologist may suggest that they 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, your child will most likely NOT experience these side effects. If they do not have symptoms, they will likely be mild.
What is “add–back” therapy?
Add–back is a pill that contains a small amount of estrogen and progestin, or progestin–only that is taken every day. Since hormones are important to keep her bones healthy, low levels of hormones can lower your child’s bone density and put them at risk for osteoporosis (thinning of the bones). The goal of add–back therapy is to give their body back just enough hormone(s) to protect their bones and control any unwanted side effects such as hot flashes and vaginal dryness that are common when taking leuprolide acetate alone. Your child’s gynecologist will decide on how much add–back medicine they will need, and give them 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?
Effects will decrease after your child stops taking the medicine. Their menstrual cycle will return within 4 to 8 weeks after their last injection. If bone density loss occurred, it may recover partially or completely.
Can my child 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 there is a family history of osteoporosis. Osteoporosis causes our bones to become fragile and break more easily. “Add–back” therapy can help prevent loss of bone density, which may allow your child to stay on the medicine longer.
What is bone density?
Bone density is a measurement of how solid and strong our bones are. Bones need to be strong and solid so they do not break easily. The adolescent and young adult years are important for bone development. Weak bones during the teenage years may negatively impact bone health later in life. Our bones need lots of nutrients, especially calcium and vitamin D. It is also important that your child eat a well–balanced diet, take a vitamin D supplement, and include foods high in calcium.
When will my child be scheduled for a bone density test?
After your child has been on leuprolide acetate for approximately 6 months, your child’s gynecologist will order a bone density scan (DXA test). This is a simple test that measures how dense (or thick) their bones are and if their bones are losing bone mass. If the DXA scan is normal and they are told to continue on the medicine, they will be scheduled for a DXA test every 1-2 years.
Is there anything my child can do to prevent bone loss?
Yes. Your child will likely be instructed to take a calcium and vitamin D supplement. 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.
They can also reduce their chances of preventing bone loss by:
- Participating in a form of *weight bearing exercise every day
- Eating calcium–rich foods
- Avoiding the consumption of large amounts of alcohol
- Not smoking
*Weight bearing or aerobic exercise involves doing an activity that supports your weight, such as walking, running, dancing, soccer, basketball, etc.
Is it possible for someone to get pregnant while on leuprolide acetate?
Although this medication works by preventing ovulation, there is a rare chance that pregnancy could occur if a teen has unprotected sex. We recommend that everyone who is sexually active use a non–hormonal birth control method such as condoms while on this medication.
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