Merck Manual

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Drugs Commonly Used to Treat Endometriosis

Drugs Commonly Used to Treat Endometriosis

Drug

Some Side Effects

Comments

Combination estrogen-progestin oral contraceptives

Ethinyl estradiol plus a progestin

Abdominal bloating, breast tenderness, increased appetite, ankle swelling, nausea, bleeding between periods (breakthrough bleeding), mood swings, and deep vein thrombosis

Rarely an increased risk of heart attack, stroke, and peripheral vascular disease

Oral contraceptives may be useful for women who wish to delay childbearing. They may be taken 3 weeks a month (cyclically) or every day (continuously), usually for 3–4 months. Then, they are stopped for 4 days and started again.

Progestins

An intrauterine device (IUD) that releases the progestin levonorgestrel

Irregular menstrual bleeding and stopping of periods (after the IUD has been in place for a while)

These IUDs release levonorgestrel for 5 years. They must be inserted and removed by a doctor. They are appropriate for women who do not wish to become pregnant or who wish to delay pregnancy.

Medroxyprogesterone acetate

Bleeding between periods, mood swings, depression, weight gain, and atrophic vaginitis (drying and thinning of the vagina's lining)

Progestins are drugs that resemble the hormone progesterone. They can be given by mouth or by injection into a muscle.

Norethindrone acetate

Irregular menstrual bleeding, mood swings, depression, and constipation

This drug is taken by mouth at bedtime. It is commonly used in birth control pills.

Androgen

Danazol

Weight gain, acne, lowering of the voice, increased body hair, hot flashes, atrophic vaginitis, ankle swelling, muscle cramps, bleeding between periods, decreased breast size, mood swings, liver malfunction, carpal tunnel syndrome, and adverse effects on cholesterol levels in the blood

Danazol, a synthetic hormone related to testosterone, inhibits the activity of estrogen and progesterone. It is taken by mouth. The usefulness of danazol may be limited by its side effects.

GnRH agonists*

Goserelin

Hot flashes, a decrease in bone density, mood swings, headache, muscle aches and stiff joints, acne, and a reduced sex drive

Goserelin is injected under the skin every 28 days. Six doses are given.

Leuprolide

Nafarelin

Hot flashes, mood swings, atrophic vaginitis, a decrease in bone density, muscle and bone aches, stiff joints, and a reduced sex drive

Leuprolide may be injected under the skin once a day or injected into a muscle once a month or once every 3 months. Nafarelin is used as a nasal spray.

Triptorelin

Hot flashes, headache, nausea, atrophic vaginitis, muscle aches, stiff joints, mood swings, reduced sex drive, and pain or irritation at the injection site

Triptorelin is injected into a muscle every 28 days for 6 doses.

GnRH antagonist

Elagolix

Hot flashes, atrophic vaginitis, a decrease in bone density, mood swings, headaches, stiff joints, muscle aches, and a reduced sex drive

If elagolix is taken for more than 6 months, doctors may give women small doses of a progestin to minimize the decrease in bone density.

* GnRH agonists are often given with a bisphosphonate (used to treat osteoporosis) or with a progestin (sometimes combined with estrogen) to reduce the effects of decreased estrogen levels, such as decreased bone density. This use of estrogen plus a progestin or of a progestin alone is called add-back therapy.

GnRH = gonadotropin-releasing hormone.