Endometriosis is a lifelong condition so it is important to develop a plan to manage it based on the extent of the disease, severity of pain and potential plans for pregnancy. Since it is a chronic disease, it cannot be cured, but there are options for different types of medications to ease endometriosis pain and help you feel better. Some need a prescription. Others you can buy “over the counter.” Your doctor may recommend that you try more than one kind.
Sometimes endometriosis pain can be severe. So, if you try pain meds that you can buy without a prescription and you don’t get enough relief, your doctor will consider whether you need a prescription for a stronger type of medicine.
Hormone Birth Control
Taking hormone birth control can stop the heavy menstrual bleeding that generally accompanies endometriosis. Your doctor may advise you to take hormonal birth control on a continuous basis for three or more months to prevent you from having your period.
The most common hormones that doctors prescribe for endometriosis include:
Birth control pills, patches, and vaginal rings. These contraceptives include both estrogen and progestin.
Progestin-only contraceptives. These include pills, shots, and an IUD (intrauterine device). These medicines can cut down on pain, as most women don’t have a period while taking these medicines, or at least have fewer periods.
Hormone therapy can cause side effects such as weight gain, depression, acne, body hair, and irregular bleeding. You should talk with your doctor about the risks and benefits. Also, if you stop taking this type of medicine, your symptoms may come back. Tell your doctor if that happens.
Gonadotroin-releasing Hormone (GnRH) Analogues
If your pain is not controlled with NSAIDS and hormone birth control, your doctor may suggest a gonadotroin-releasing hormone (GnRH) analogue. This medication causes your ovaries to stop producing estrogen, which in turn causes the endometriosis tissue to shrink. Over 80% of women using this treatment had their pain reduced, including those with severe pain. GnRH analogues also cause you to experience temporary menopause so they are not used if you are trying to become pregnant.
There are 2 types of GnRH analogues – GnRH agonists and antagonists.
Examples of GnRH agonist analogue include:
- Goserelin ( Zoladex ) – Shot taken once every 28 days
- Leuprolide (Lupron) – Shot taken once every one or three months
- Nafarelin (Synarel) – Nasal spray taken twice per day
Examples of GnRH antagonist analogue include:
- Elagoliz (Orlissa) - Tablet are taken because of bone density loss that can increase the risk of fractures. It is taken by mouth one-two times a day, depending on your symptoms
Doctors limit the number of months these meds are taken because of bone density loss that can increase the risk of fractures.
Androgen Receptor Agonist
The medication danazol (Danocrine) helps stop your body from releasing hormones that it uses to help bring about your period and increases your immune system. You need to be on birth control while you take it to prevent pregnancy. If you get pregnant while taking danazol, it could cause a female baby to have male traits.
Aromatase is a chemical that boosts your body’s estrogen production. Aromatase inhibitors block it, which lowers your estrogen level. These medicines aren’t routinely used to treat endometriosis. But in some cases, doctors recommend it "off label" in addition to hormonal therapy to manage endometriosis pain, as long as you aren’t planning to get pregnant while on this treatment.