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Endometriosis

Medications To Treat Endometriosis

Last modified: 
22/03/2012 - 12:01

Contributing Author: Guy Slowik FRCS

For women with mild to moderate symptoms, medication may be the best treatment option. A course of medication is also sometimes prescribed along with conservative surgery.

Medications to treat endometriosis include:

Pain Relievers

Over-the-counter pain relievers may include aspirin, acetaminophen (such as Tylenol), ibuprofen (such as Advil), naproxen sodium, indomethecin, and tolfenamic acid. In some cases, prescription pain-killing medication may be helpful.

Hormonal Treatments

Hormonal treatment is the mainstay of prescription medication for endometriosis. Treatment with medication is based on two important observations:

  • The symptoms of endometriosis tend to improve during pregnancy.
  • The symptoms of endometriosis tend to improve after menopause.

From these observations, two treatments have evolved:

  • Pseuodopregnancy medical therapies, which are drugs that fool the body into thinking it is pregnant. These include oral contraceptives and progesterone.
  • Pseudomenopause medical therapies, which are drugs that fool the body into thinking that it is past menopause. These include danazol and GnRH agonists.

Oral Contraceptives

When it was introduced, pseudopregnancy therapy (fooling the body into thinking it is pregnant) with high-dose birth control pills was an important advance in the treatment of endometriosis. This approach is used less now, since the introduction of other treatments.

However, in some women, oral contraceptives (birth-control pills) are the best option. The type of oral contraceptive used is the combination birth control pill (which contains two female hormonesestrogen and progestin).

Oral contraceptives cannot cure endometriosis, but they can be effective in temporarily relieving the pain. They do this by stopping the monthly hormonal cycle, which causes the endometrial tissue to swell.

Minor side effects include abdominal swelling, breast tenderness, increased appetite, ankle swelling, nausea, and bleeding between periods. In rare cases, oral contraceptives can cause deep vein thrombosis (blood clots).

Need To Know:

Research has proven that smoking and taking oral contraceptives (birth control pills) significantly increases a woman's risk for stroke. Together, they can cause blood clots to form. Women who smoke should not take oral contraceptives.

Progesterone

Progesterone is one of the female sex hormones produced by the ovary that prepares the lining of the uterus for implantation of a fertilized egg. Given orally or by injection, progesterone induces a simulated state that mimics pregnancy. This relieves the symptoms of endometriosis by stopping the monthly swelling and discharge of the endometrial tissue.

Progestogens (drugs with properties similar to progesterone) that are used for treating endometriosis include medroxyprogesteron acetate, norethisterone, and norgestrel. Many women respond well to this treatment, but some experience side effects that include:

  • Irregular menstrual bleeding (a common side effect)
  • Weight gain
  • Acne
  • Mood swings
  • Depression

Danazol

Since its introduction in 1971, danazol has become the main drug treatment for endometriosis.

Unlike oral contraceptives and progesterone, which induce a pregnancy-like state, danazol is a synthetic male hormone that relieves the pain of endometriosis by temporarily stopping the monthly hormonal cycle that causes endometrial tissue to swell.

Although it is true that danazol is a synthetic hormone, it can be thought of as an "anti-hormone," since many of its actions oppose the effects of estrogen, the main female hormone. Although danazol does not increase the total amount of testosterone (male hormone) in a woman's body, it renders it more biologically active.

Need To Know:

Because danazol can be harmful to a fetus if taken during pregnancy:

  • A woman should begin taking it on the first day of a period to ensure that she is not pregnant, and
  • A woman and her partner should use effective birth control methods to ensure a pregnancy does not occur while she is taking danazol.

Danazol is a very effective medication; it improves the symptoms of endometriosis in more than 95 percent of the women who take it. It is usually taken for six months. However, danazol can produce a number of side effects, including:

  • Acne
  • Greasy skin
  • Weight gain
  • High cholesterol levels
  • Increase in body hair growth
  • Voice changes
  • Disruption of menstrual cycle
  • Hot flushes and sweats
  • Reduced sex drive
  • Indigestion and stomach upsets
  • Dizziness
  • Reduced breast size
  • Muscle cramps
  • Irritability
  • Headaches
  • Tiredness

However, only a small percentage of women (5 to 10 percent) chose to discontinue danazol because of side effects. Most do not experience major problems and can complete the course of treatment. Women who become pain-free while on danazol often feel very well.

Treatment with danazol usually lasts six to nine months. Any side effects from danazol are reversible, and women will often tolerate them in exchange for the relief of the pain caused by endometriosis. When the medication is stopped, a woman's fertility (ability to become pregnant) returns in two to three months.

Need To Know:

Danazol should not be taken by:

  • Women who are or may be pregnant
  • Women who are breast-feeding
  • Women with occupations dependent on voice quality, such as singers, because there is a small risk of voice changes

Also, women who experience migraine headaches should be aware that the migraines might worsen during treatment.

GnRH Agonists

GnRH agonists is an abbreviation for gonadotropin-releasing hormone analogues. The role of this group of drugs is to suppress the pituitary gland.

The pituitary gland normally produces hormones that act on the ovary, which in turn produces the female sex hormones, estrogen and progesterone. By "turning off" the pituitary, the ovary is also "turned off." As a result, the ovaries stop ovulating and no longer produce estrogen. The overall effect is termed "medical menopause."

This group of drugs is proven to be effective in treating endometriosis, but they also tend to produce side effects that include:

  • Vaginal dryness
  • Mood swings
  • Hot flashes (a more common side effect)

Unlike danazol, they do not raise cholesterol levels. But they do cause calcium loss from bone, which can result in osteoporosis. Less common side effects include decreased sex drive, reduced breast size, bloating, and excess hair growth.

The GnRH agonists (known also as GnRH analogues) are given as a monthly injection or daily nasal spray and have become a popular (although more expensive) alternative to danazol. These drugs include Lupron, Synarel, and Zoladex.

As with danazol, GnRH agonists should not be taken during pregnancy, so effective contraception methods should be used. A woman's menstrual period will resume about two months after discontinuing the medication, and fertility usually returns in one to two months.

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Endometriosis

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From Andrew Maynard - Chair of the University of Michigan Department of Environmental Health Sciences, with help from David Faulkner - 2013 Master of Public Health graduate.