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Medications for Endometriosis

The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your healthcare provider if you need to take any special precautions. Use each of these medications as recommended by your healthcare provider, or according to the instructions provided. If you have further questions about usage or side effects, contact your healthcare provider.

Prescription Medications

Gonadotropin-Releasing Hormone (GnRH) Agonist

  • Leuprolide Acetate (Lupron Depot)
  • Nafarelin Acetate (Synarel)
  • Goserelin Acetate (Zoladex)

Androgen/Estrogen-Antagonist

  • Danazol (Danocrine, Cyclomen)

Progestins

  • Medroxyprogesterone Acetate (Depo-Provera)
  • Norethindrone (Aygestin)
  • Norlutate
  • Progestin-containing Intrauterine Device: Levonorgestrel-releasing intrauterine system (Progestasert, Mirena)
  • Combined estrogen/progesterone oral contraceptives

Aromatase Inhibitors

  • Anasrozole
  • Letrozole
  • Exemestrane

Over-the-Counter Medications

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

  • Ibuprofen (Advil, Motrin)
  • Naproxen sodium (Aleve)

Prescription Medications

Gonadotropin-Releasing Hormone (GnRH) Agonist

Common names include:

  • Leuprolide (Lupron Depot)
  • Nafarelin Acetate (Synarel)
  • Goserelin Acetate (Zoladex)

GnRH agonists block the release of hormones that cause ovulation. As a result, estrogen is not produced. This stops the menstrual cycle and helps to relieve the symptoms of endometriosis.

For women with endometriosis, GnRH agonists can have the following health benefits:

  • Pain relief (by the second or third month)
  • Shrinkage of the endometrial growths
  • Delay of a recurrence of endometriosis after surgery
  • Improved quality of life

A GnRH agonist can be given by injection or through a nasal spray. It is usually prescribed for six months or more. Side effects are common and can vary depending on the drug taken. They can be severe in some women.

Possible side effects include:

  • Bone density loss
  • Hot flashes and night sweats
  • Difficulty sleeping
  • Lowered sex drive
  • Headache
  • Muscle ache
  • Nausea and vomiting
  • Memory loss
  • Fast heartbeat
  • Changes in the skin and hair
  • Dryness or burning in the vagina
  • Gain or loss of weight
  • Depression
Special Considerations

GnRH agonists have been shown to decrease bone density. Talk to your doctor about this risk; it may affect how long you can take these drugs. Because of this problem you may need to take a calcium supplement.

GnRH agonists are known to cause birth defects. Do not take this medication if there is a chance that you can become pregnant.

Androgen/Estrogen-Antagonist

Common names include:

  • Danazol (Danocrine, Cyclomen)

Danazol is a synthetic androgen, which is a male hormone. Danazol helps relieve the symptoms of endometriosis by stopping reproductive hormones from being made and by stopping the menstrual cycle.

Danazol can have the following benefits:

  • Pain relief
  • Shrinkage of endometrial growths

Danazol is taken in pill form, typically three times per day for 6-9 months at a time. It is sometimes given with oral contraceptives to decrease possible side effects. Most of the side effects are due to the effects of the male hormone. Most are relatively mild and stop when treatment stops.

Possible side effects include:

  • Increase in low density lipoprotein (LDL) (bad) cholesterol levels
  • Changes in blood sugar levels
  • Facial hair
  • Weight gain
  • Dandruff
  • Deepening of the voice
  • Decreased breast size
  • Acne
  • Oily skin
  • Irritation in the vagina
  • Hot flashes
  • Mood swings
Special Considerations

Danazol is known to cause birth defects. Do not take this medication if there is a chance that you can become pregnant.

Progestins
  • Medroxyprogesterone Acetate (Depo-Provera)
  • Norethindrone (Aygestin)
  • Combined estrogen/progesterone oral contraceptives
  • Progestin-containing Intrauterine Device: Levonorgestrel-releasing intrauterine system (Progestasert, Mirena)

Progestin is one of the hormones that are naturally released by the ovary during the menstrual cycle. Taken as medication, it stops ovulation and the menstrual cycle. Progestins can be very effective for controlling the mild-to-moderate symptoms of endometriosis. They can be given as long-term therapy and can be especially useful in women who do not want to become pregnant.

Progestins can have the following health benefits:

  • Pain relief
  • Improved quality of life
  • Reduce recurrence of endometrial growths after surgery (combined birth control pills)

Progestins are taken in pill form, by injection, or by delivery from an intrauterine device. Injections are typically given once every three months. Progestin in pill form can be given as progestin alone or as an estrogen/progestin-combined oral contraceptive. In pill form, it is taken once per day and should be taken at approximately the same time every day. If it causes nausea, it should be taken just before bedtime.

Possible side effects include:

  • Irregular spotting
  • Weight gain
  • Mood swings
  • Headaches
  • Breast tenderness
  • Acne
Aromatase Inhibitors
  • Anasrozole
  • Letrozole
  • Exemestrane

Aromatase inhibitors may have a role in the future for treating endometriosis. In premenopausal women, such as women with endometriosis, aromatase inhibitor regimens require concomitant ovarian suppression with a GnRH agonist, progestin, or combined oral contraceptive. The most attractive combination is probably the oral contraceptive plus aromatase inhibitor. The side effects are comparable to other treatments, but do not include the risk of bone density loss experienced with GnRH agonist.

Over-the-Counter Medications

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Common names include:

  • Ibuprofen (Advil, Motrin)
  • Naproxen sodium (Aleve)

NSAIDs are pain relievers. If pain is expected (for example, during your menstrual period), these medications work best when taken on a scheduled rather than an as-needed basis. The dose depends on the amount of pain. For severe pain, NSAIDs are available in higher doses by prescription. These medications should be taken with food and a full glass of water.

NSAIDs are known to increase bleeding. If you are going to have surgery or a biopsy, tell your healthcare provider that you are taking these medications. Also, they should be used with caution if you have a stomach ulcer, high blood pressure, kidney disease, or are taking blood thinners.

Special Considerations

Whenever you are taking a prescription medication, take the following precautions:

  • Take them as directed—not more, not less, not at a different time.
  • Do not stop taking them without consulting your healthcare provider.
  • Do not share them with anyone else.
  • Know what effects and side effects to expect, and report them to your health care provider.
  • If you are taking more than one drug, even if it is over-the-counter, be sure to check with a physician or pharmacist about drug interactions.
  • Plan ahead for refills so you do not run out.

Revision Information

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  • Allen C, Hopewell S, et al. Non-steroidal anti-inflammatory drugs for pain in women with endometriosis. Cochrane Database of Systematic Reviews. 2005;(4):CD004753.

  • Appleyard TL, Mann CH, et al. Guidelines for the management of pelvic pain associated with endometriosis: a systematic appraisal of their quality. BJOG. 2006;113(7):749-757.

  • Attar E, Bulun SE. Aromatase inhibitors: the next generation of therapeutics for endometriosis? Fertil Steril. 2006;85:1307-1318.

  • The Endometriosis Association website. Available at: http://www.endometriosisassn.org. Accessed March 1, 2006.

  • Endometriosis Research Center website. Available at: http://www.endocenter.org. Accessed March 1, 2006.

  • Farquhar C, Sutton C. The evidence for the management of endometriosis. Curr Opinion in Obstet & Gynecol. 1998;10(4):321-332.

  • Gabbe, SG. Obstetrics: Normal and Problem Pregnancies. 5th ed. London: Churchill Livingstone, 2007.

  • Katz VL. Comprehensive Gynecology. 5th ed. St. Louis: Mosby, 2007.

  • Kistner’s Gynecology and Women’s Health. 7th ed. Mosby-Year Book; 1999.

  • Medical Management of Endometriosis. The American College of Obstetricians and Gynecologists, Practice Bulletin No. 11. Dec 1999.

  • Moore J, Kennedy S, et al. Modern combined oral contraceptives for pain associated with endometriosis. Cochrane Database of Systematic Reviews. 2000;(2):CD001019.

  • National Institute of Child Health and Human Development website. Available at: http://www.nichd.nih.gov. Accessed March 1, 2006.

  • National Women’s Health Resource Center website. Available at: http://www.healthywomen.org. Accessed March 1, 2006.

  • Rakel R. Textbook of Family Medicine 2007. 7th ed. Philadelphia: Saunders Elsevier, 2009.

  • Rakel RE, Bope ET. Conn's Current Therapy. 60th ed. Philadelphia: Saunders Elsevier, 2009.

  • Razzi S, Fava A, et al. Treatment of severe recurrent endometriosis with an aromatase inhibitor in a young ovariectomised woman. BJOG. 2004;111:182-184.

  • Selak V, Farquhar C, et al. Danazol for pelvic pain associated with endometriosis [update]. Cochrane Database of Systematic Reviews. 2001;(4):CD000068.

  • Shippen E, West WJ. Successful treatment of severe endometriosis in two premenopausal women with an aromatase inhibitor. Fertil Steril. 2004;81:1395-1398.

  • Surrey ES, Hornstein MD. Prolonged GnRH agonist and add-back therapy for symptomatic endometriosis: long-term follow-up. Obstet & Gynecol. 2002;99(5):709-719.

  • Vercellini P, Cortesi I, et al. Progestins for symptomatic endometriosis: a critical analysis of the evidence. Fertility & Sterility. 1997;68(3):393-401.

  • Yap C, Furness S, et al. Pre and post operative medical therapy for endometriosis surgery. Cochrane Database of Systematic Reviews. 2004;(3):CD003678.

  • 3/12/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Seracchioli R, Mabrouk M, et al. Long-term cyclic and continuous oral contraceptive therapy and endometrioma recurrence: a randomized controlled trial. Fertil Steril. 2010;93(1):52-56.