Hormonal Therapy Options
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|Endometriosis and College Planning|
You may already know about the different medical options for managing endometriosis. These options are based on scientific research. There is no available cure for endometriosis at this time, and if left untreated, it will grow, causing pain and lowering your chances of being able to become pregnant in the future. Therefore, treatment is aimed at controlling pain and preventing the endometriosis from getting worse. This guide was created to help you understand different types of hormonal treatment for endometriosis, as well as the benefits and possible side effects that are most commonly reported.
How do I know if hormone treatment is right for me?
Most young women can take hormone medicine, however, if you have certain medical conditions (such as a history of blood clots, high blood pressure, certain kinds of heart disease, hepatitis, severe migraines, or if you smoke), hormonal therapy may not be an option for you. Be sure to tell your healthcare provider if you have migraine headaches with loss of vision, flashing lights, numbness/tingling, or loss of speech. Also, it is very important to let your medical team know if anyone in your family has ever had a blood clot or stroke.
How does hormonal treatment work?
Hormonal treatment works by temporarily turning off your ovaries so you don't ovulate (make eggs). When you don't ovulate, you don't have regular periods. When you are prescribed hormonal treatment continuously, you will rarely have periods, or you won't have them at all. Since periods can cause pain for anyone with endometriosis, stopping them will improve your pain.
Hormonal Therapy with Combined Estrogen and Progestin
Oral Contraceptive Pills (OCP's): OCP's contain the hormones estrogen and progesterone. The goal of the treatment is to stop your periods and pain. Teens with endometriosis will often take them in a continuous fashion. Oral contraceptive pills work by temporarily turning off your ovaries. This type of treatment is common for dysmenorrhea (painful periods) and other pelvic pain that occurs with endometriosis.
The Patch: The patch is a type of hormone therapy that looks like a square adhesive bandage. It contains hormone medicine similar to birth control pills and is worn on your skin. Like birth control pills, the patch may be prescribed for irregular periods, menstrual cramps, and endometriosis. Each hormone patch lasts one week. You change it every week for 3 weeks then you have a "patch-free" week. During the "patch-free" week you will get your period. Some girls and women prefer the patch instead of OCP's because they don’t need to remember to take it everyday.
The Vaginal Ring: The vaginal ring is a small, thin, flexible rubber ring that fits inside the vagina. Once in place it releases a combination of estrogen and progestin (hormones). Similar to OCP's and the patch, the vaginal ring may be used to treat symptoms of endometriosis by controlling your menstrual cycle. When you use this method of cyclic hormone therapy, you remove the ring after the third week, leave it out for one week, and then replace it after 7 "ring free" days. If your healthcare provider wants you to take it continuously, you would keep it in for 3 weeks straight, and then take it out and replace it with a new one right away. (If you are sexually active, neither you nor your partner will be able to feel it when it is inserted properly.)
Benefits of Hormonal Therapy with Combined Estrogen and Progestin:
- Combined estrogen and progestin hormonal therapy may decrease, and in some cases stop endo pain
- Most girls have 0-4 periods a year
Possible Side Effects of Hormonal Therapy with Combined Estrogen and Progestin:
- Spotting or breakthrough bleeding can last for a few days until your body gets used to the medicine, or as long as you are taking it
- Some girls may have heavier bleeding or a regular period
- Breast tenderness, mood swings, headaches, nausea, cramps, bloating, and/or weight gain
- There is some concern that the patch may release a higher dose of hormones than the Pill, which can increase the risk of blood clots and/or stroke
- Some girls who use the patch may have skin irritation where it is worn
- Some girls who use the vaginal ring may have vaginal irritation
- Some girls may not have relief from their endometriosis pain
Progesterone-Only Hormonal Therapy
Norethindrone acetate: Norethindrone acetate (Aygestin®) is a pill that contains only progesterone. It is a type of hormone medicine that is often prescribed for patients that can't take estrogen. The dosage is 5–15mg per day, and can be individualized for each patient.
Medroxyprogesterone acetate: Medroxyprogesterone acetate (Depo Provera®) is another type of medication that contains only the hormone progesterone. It's given as an injection once every 3 months. Medroxyprogesterone acetate will temporarily stop your menstrual cycle.
Benefits of Progesterone-Only Hormonal Therapy:
- Progesterone based hormone therapies can be effective in treating symptoms of endometriosis
Possible Side Effects:
- Spotting or break-through bleeding can last for a few days until your body gets used to the medicine, or as long as you are taking it
- Bleeding or a regular period
- Breast tenderness, mood swings, nausea, bloating, weight gain, and/or hair thinning
- Bone density loss and increased risk of osteoporosis (thinning of your bones) when taken for a long time
- Some girls may not have relief from their endometriosis pain
Hormonal Therapy with GnRH agonists (Gonadotropin Releasing Hormone agonists)
This type of hormone works by temporarily turning off your pituitary gland and your ovaries. This makes your ovaries think that you are pre-pubertal (the time before puberty) because your ovaries stop making estrogen and progesterone. The lack of estrogen in your body causes your periods to stop. Since all GnRH agonists lower estrogen levels, the possible side effects for all of the medicines in this group are the same and are often associated with menopause-like symptoms. While taking GnRH agonists, it's important to get enough calcium, either in your diet or by taking calcium supplements. Your body needs 1300mg of calcium every day.
GnRH agonists and Hormonal “Add-back” Therapy
Add–back therapy is a small amount of progesterone, or a combination of estrogen and progesterone. The goal of GnRH agonists and add–back therapy is to stop the endometriosis from growing, protect your bones, and lower the side effects of hormonal therapy with GnRH agonists alone.
Leuprolide acetate: Leuprolide acetate (Lupron-Depot®) is one type of GnRH agonist (hormone medicine) that is given as an intramuscular (in the muscle) injection. It can be given as a once a month injection (white container) or once every 3 months (blue container). As you might expect, the monthly injection works for about one month, and the three-month injection works for about 3 months.
Nafarelin acetate: Nafarelin acetate (Synarel®) is another type of GnRH agonist that comes in the form of a nasal spray. The recommended dose is one puff in one nostril in the morning, then another puff in the other nostril at nighttime.
Benefits of GnRH agonists and Hormonal "Add-back" Therapy:
- Low levels of estrogen cause your period to stop and endometriosis from growing
- Low levels of estrogen stop endometriosis from growing so your fertility is preserved
Possible Side Effects of GnRH agonists and Hormonal "Add-back" Therapy:
- Hot flashes, mood swings, vaginal dryness, bone and joint aches, hair loss, lack of interest in sex, and possible short–term memory loss
- Some girls may continue to have mild side effects associated with "menopause-like" symptoms even with the add-back therapy
- Some girls may not have relief from their endometriosis pain.
In many cases, teens and young women may be able to stay on a GnRH agonist longer than six months as long as they are on add-back therapy and their bone density is normal.
Remember, all medicines affect each person differently. It usually takes about 2–3 months to see an improvement in symptoms and for your body to get used to any new medicine. Side effects will go away soon after the medication is stopped and your menstrual cycle returns. Deciding what treatment is best for you may take some time. Talk with your health care provider about any concerns or questions you might have. In the meantime, you can help your body feel better by eating well and getting plenty of exercise and rest.
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