Guest Author - Dr. Denise Howard
Endometriosis is a chronic, relapsing condition that may plaque some women their entire reproductive life. There is a wide range of analgesics and hormonal medication that are effective in the management of endometriosis related pain in a large percentage of women. In some cases, this treatment is insufficient and other treatment options should be explored.
Gonadotropin releasing hormone (GnRH) agonists are one of the most commonly used medications in the treatment of severe or persistent endometriosis. They are similar to the hormone, gonadotropin-releasing hormone produced in the brain. GnRH is a hormone released in the brain that tells the pituitary to release FSH and LH, which in turn tells the ovary to ovulate. GnRH agonists binds to the GnRH receptors changing the message delivered to the pituitary gland. The release of eggs from the ovary is temporarily suspended and estrogen production drops. The endometriosis shrinks. This treatment is typically used for 6 months but can be used longer under select circumstances.
There are 3 widely available GnRH agonists. Leuprolide (Lupron) is an intramuscular injection, which can be given as a monthly or 12 weekly injection. Goserelin (Zoladex) is given as a subcutaneous implant, which also is prescribed monthly or every 12 weeks. Nafarelin (Synarel) is given as a twice daily nasal spray. These medications produce a medical menopause, which lasts as long as the medication is prescribed. In menopause the estrogen levels are extremely low and the endometriotic implants resolve due to a lack of estrogen. The most common side effects are the menopause related ones. These include hot flashes, night sweats, urogenital atrophy, bone loss and sleep disturbance. Most of these symptoms can be managed with add-back therapy. Treatment results in an 85% reduction in pelvic pain, pain with intercourse, and menstrual pain.
An older and now less widely used treatment is Danazol. It has a progestin like effect and has been shown to reduce mild to moderate endometriosis related pain by 80% at 2 months. The dose is 400-800 mg daily. The androgenic side effects of acne, facial hair, decrease breast density and other masculinizing symptoms makes it much less popular than other treatments.
The development of aromatase inhibitors has provided an additional tool in the treatment of hormonally related problems. Two of the most common aromatase inhibitors are Anastrozole 1 mg daily and Letrozole 2.5 mg daily. These medications work by blocking the production of estrogen thus creating a menopause like state. The side effects are therefore similar to the GnRH agonists.
Having a wide range of medications available to treat endometriosis allows women and their doctors to have choices. Not every medication is tolerable, advisable or even financially feasible for every woman. If you suffer from endometriosis, you should partner with your gynecologist to choose the therapy that is right for you.
I hope this article has provided you with information that will help you make wise choices, so you may:
Live healthy, live well and live long!