Endometriosis for Parents: Leuprolide Acetate with Add–Back

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 progestin or progestin alone. Your daughter must take add–back therapy if she is prescribed leuprolide acetate.

How does leuprolide acetate work?

This medication works by shutting off hormones made by your daughter’s ovaries, so her estrogen (one of the hormones that causes her body to have periods) level is lowered. After her first injection, her estrogen level will rise before it goes down. This is called an “estrogen surge.” Because of this rise in estrogen, she may have an increase in her endo symptoms for a few days. After the estrogen surge, her estrogen levels will go down. This temporarily stops her period. Without periods endometriosis symptoms usually go away.

How is leuprolide acetate given?

Leuprolide acetate is an injection. It is very important that your daughter gets her injection on time. Missed doses can cause breakthrough bleeding and the return of pain.

How long can my daughter 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 daughter will be scheduled for a follow–up appointment with her gynecologist to see if the medicine is helping her. This appointment also gives your daughter’s gynecologist a chance to ask her about her pelvic pain and any other symptoms she may be having. If her symptoms are better, her gynecologist may suggest that she 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 daughter will most likely NOT experience these side effects. If she does 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 daughter’s bone density and put her at risk for osteoporosis (thinning of the bones). The goal of add–back therapy is to give her body back just enough hormone(s) to protect her bones and control any unwanted side effects such as hot flashes and vaginal dryness that are common when taking leuprolide acetate alone. Your daughter’s gynecologist will decide on how much add–back medicine she will need, and give her 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 daughter stops taking the medicine. Her period will return within 4 to 8 weeks after her last injection. If bone density loss occurred, it may recover partially or completely.

Can my daughter 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 daughter 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 daughter eat a well–balanced diet, take a vitamin D supplement, and include foods high in calcium.

When will my daughter be scheduled for a bone density test?

After your daughter has been on leuprolide acetate for approximately 6 months, your daughter’s gynecologist will order a bone density scan (DXA test). This is a simple test that measures how dense (or thick) her bones are and if her bones are losing bone mass. If the DXA scan is normal and she is told to continue on the medicine, she will be scheduled for a DXA test every 1-2 years.

Is there anything my daughter can do to prevent bone loss?

Yes. Your daughter 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.

She can also reduce her 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 a young woman 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 young woman has unprotected sex. We recommend that young women who are sexually active use a non–hormonal birth control method such as condoms while on this medication.

It’s important to remember that all medications affect people differently. If your daughter experiences side effects, have her talk with a member of the GYN team. It usually takes 2–3 menstrual cycles to see an improvement in symptoms and for a young womans body to get used to this medicine. In the meantime, your daughter can help her body feel better by eating well and getting plenty of rest and exercise.