Drug Treatments for Endometriosis

Medical drug treatment for endometriosis focuses on managing pain and regulating hormones. This is currently achieved by prescription or over the counter painkillers, hormonal contraceptives, and GnRH analogues.


Endometriosis drug treatments


The aim of hormone drug treatment is to stop further growth of the disease by blocking the hormones in the body. They either put the woman into a pseudo-pregnancy or pseudo-menopause. (Pseudo means simulated or artificial – both states are reversed when the patient has stopped taking the hormones.)

All drug treatments have the possibility of causing side effects and some of these can be somewhat severe. However, each person is individual as to how they react to certain drug treatments but it is important to be aware of any possible side effects.

The first line of treatment is often  the Birth Control Pills (BCP) which is prescribed to reduce pelvic pain, make periods lighter, and stop ovulation. Birth Control Pills do not remove existing lesions or damage or cure the underlying cause. They simply slow the progression of the disease. 


Hormonal Management to Prevent Menstruation or Ovulation

Drugs that mimic Pregnancy

Combined Hormonal Contraceptives: The combination of these hormones in the pill is similar to that in pregnancy, causing the menstrual cycle to stop, hence the symptoms of endometriosis being reduced.   Birth control pills, patches, or vaginal rings reduce or stop monthly periods, which lowers the buildup and bleeding of endometrial tissue.

Both combined oral contraceptive pills (estrogen and progestin) and progestin-only pills are used to treat endometriosis pain. They are often prescribed to be taken continuously (back-to-back without a monthly break) to stop periods and reduce symptom flare-ups.

Possible Side effects - irregular bleeding, headaches, breast tenderness, mood changes and nausea. Possible serious side effects - Blood clots: Higher risk of deep vein thrombosis, mostly with estrogen-containing options. Blood pressure: Small increases in blood pressure levels.

Progestin-Only Options: Treatments like the Mirena IUD, progestin-only pills (e.g., dienogest, norethindrone acetate), or injections (Depo-Provera) thin the womb lining and limit tissue growth.

Progesterone or progestin-only pills treat endometriosis by stopping ovulation, thinning the endometrial tissue, and lowering estrogen levels to reduce pain and shrink lesions.

Possible side effects - headaches, breast discomfort, acne, depressed mood, headaches and weight gain.

Drugs the mimic Menopause

GnRH Analogues and Blockers: GnRH analogues stop the production of the hormones FSH and LH. The ovaries switch off and temporarily stop producing eggs and the hormone estrogen. Medications like goserelin, leuprorelin - oral combination therapies temporarily lower estrogen levels to induce a low-hormone state that help shrinks lesions, sometimes paired with add-back hormone replacement therapy to reduce side effects.

Bleeding and endometriosis-specific medications: these are are progestins at higher doses (Visanne, norethindrone) Used to treat the painful symptoms of endometriosis by shrinking misplaced uterine tissue and lowering estradiol levels. Both of these helps to manage endometriosis and are not a cure.

Possible side effects - menstrual changes, headaches, weight gain, acne, hair loss, joint stiffness, bone thinning, trouble sleeping, mood shifts and depression.

Add back HRT for GnRH treatment - HRT is typically used to reduce the symptoms that menopausal women may experience, so as GnRH analogues create a pseudo menopausal state, it can also be used to minimise the symptoms of this treatment. This is also known as ‘addback’ therapy.

Tranexamic acid

Can be prescribed to help reduce heavy menstrual bleeding. Tranexamic acid tablets for heavy periods are also available to buy from pharmacies, for adults aged 18 and over. Tranexamic acid helps the blood in the womb to form clots, which reduces the amount of bleeding. Mefenamic acid is an anti-inflammatory medication.

Possible unwanted side effects: May cause indigestion and/or diarrhoea. Women who have had a blood clot in their leg or lung should not use tranexamic acid.


endo pain management


Pain Management Medication

1.  Pain medication for chronic pain that is safe on the stomach like NSAIDs

2.  Nerve-related medication for central sensitization - Low-Dose Naltrexone, Amitriptyline

3.  Limited use emergency medication for really bad days - Codeine, Toradol etc.

4.  Other drugs used include anti-epileptic drugs (gabapentin and pregabalin), which work on the neurons to reduce pain signals.

5.  Anti-depressants - Although anti-depressants are produced to treat depression – they also help block neurotransmitters carrying messages of pain into the brain. Anti-depressants are often prescribed for the management of chronic pain. They may not work for everyone and can have side-effects.


The Birth Control Pill is often the first option of hormone treatment offered for women with endometriosis. Learn more ...




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References:

EndometriosisNews - Depo Provera

National Women's Health Network - what does Lupron do to a woman's health

https://en.wikipedia.org/wiki/Endometriosis

http://endometriosis.org/treatments/

 



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