Medications for Endometriosis

Here are the basics about each of the medicines below. Only common problems with them are listed.

Prescription Medications

Gonadotropin-Releasing Hormone (GnRH) Agonist

  • Leuprolide Acetate
  • Nafarelin Acetate
  • Goserelin Acetate
  • Elagolix

Androgen/Estrogen-Antagonist

  • Danazol

Progestins

  • Medroxyprogesterone Acetate
  • Norethindrone
  • Norlutate
  • Progestin-containing intrauterine device: levonorgestrel-releasing intrauterine system
  • Combined estrogen/progesterone oral contraceptives

Aromatase Inhibitors

  • Anasrozole
  • Letrozole
  • Exemestrane

Over-the-Counter Medications

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

  • Ibuprofen
  • Naproxen sodium

Prescription Medications

Gonadotropin-Releasing Hormone (GnRH) Agonist

Common names are:

  • Leuprolide Acetate
  • Nafarelin Acetate
  • Goserelin Acetate
  • Elagolix

These medicines block the release of hormones that cause ovulation. As a result, estrogen is not made. This stops the menstrual cycle and helps to ease problems.

These can:

  • Ease pain by the second or third month
  • Shrink growths
  • Reduce the chance of growths coming back after surgery
  • Improve quality of life

These medicines can be given by injection or through a nasal spray. They are taken for 6 months or more. Side effects are common and depend on the drug that is taken. They can be severe.

Some problems are:

  • Bone density loss
  • Hot flashes and night sweats
  • Problems sleeping
  • Low sex drive
  • Headache
  • Muscle ache
  • Nausea and vomiting
  • Memory loss
  • Fast heartbeat
  • Skin and hair changes
  • Vaginal dryness or burning
  • Gain or loss of weight
  • Depression

This medicine can decrease bone density. It may affect how long it can be taken. It may need to be taken with a calcium supplement. It may also cause birth defects. Women who may become pregnant should not take this medicine.

Androgen/Estrogen-Antagonist

Danazol is an androgen, which is a male hormone. It helps ease problems by stopping reproductive hormones from being made. It also stops the menstrual cycle.

It can:

  • Ease pain
  • Shrink growths

It is taken as a pill for 6 to 9 months. It may be given with oral contraceptives to lower the chance of problems. Most are mild and go away when it is stopped.

Some problems are:

  • Higher LDL ("bad") cholesterol
  • Changes in glucose levels
  • Facial hair
  • Weight gain
  • Dandruff
  • A deeper sounding voice
  • Smaller breast size
  • Acne
  • Oily skin
  • Irritation in the vagina
  • Hot flashes
  • Mood swings

It may cause birth defects. Women who may become pregnant should not take this medicine.

Progestins

  • Medroxyprogesterone Acetate
  • Norethindrone
  • Combined estrogen/progesterone oral contraceptives
  • Progestin-containing intrauterine device: levonorgestrel-releasing intrauterine system

Progestin is a hormone that is released by the ovary during the menstrual cycle. It stops ovulation and the menstrual cycle when it is taken as a medicine. It can help manage mild-to-moderate symptoms. It can also be given as long-term therapy. They are a good choice for women who do not want to become pregnant.

It can:

  • Ease pain
  • Improve quality of life
  • Reduce the chance of growths coming back after surgery (when taken with birth control pills)

They are taken in pill form, by injection, or through an intrauterine device. Injections are typically given once every 3 months. Pills can be given alone or as an estrogen/progestin-combined oral contraceptive. The pill should be taken once per day at about the same time. It should be taken before going to sleep if nausea is a problem.

Some problems are:

  • Spotting
  • Weight gain
  • Mood swings
  • Headaches
  • Tender breasts
  • Acne
  • Nausea

Aromatase Inhibitors

  • Anasrozole
  • Letrozole
  • Exemestrane

Premenopausal women must take this medicine with a GnRH agonist, progestin, or a combined oral contraceptive. A combined oral contraceptive and aromatase inhibitor is most often used. Bone density loss is a risk when it is taken with a GnRH agonist.

Over-the-Counter Medicine

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Common names are:

  • Ibuprofen
  • Naproxen sodium

NSAIDs are pain relievers. They work best when taken on a schedule. The dose depends on the amount of pain. They are available in higher doses by prescription to treat severe pain. They should be taken with food and a full glass of water.

NSAIDs can increase bleeding. People having surgery or a biopsy should talk to their doctors before taking this medicine. They should be used with care in people who have a stomach ulcer, high blood pressure, kidney disease, or those who are taking blood thinners.

References:

Brown R, Byrne D, et al. National Institute for Health and Care Excellence (NICE) guideline NG73. Endometriosis: diagnosis and management. National Guideline Alliance (UK). NICE 2017 Sep.
Endometriosis. ACOG website. Available at: https://www.acog.org/Patients/FAQs/Endometriosis. Updated January 2019. Accessed November 12, 2019.
Endometriosis. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/endometriosis. Updated August 30, 2019. Accessed November 12, 2019.
Endometriosis. Office on Women's Health website. Available at: https://www.womenshealth.gov/a-z-topics/endometriosis. Updated April 1, 2019. Accessed November 12, 2019.
Last reviewed September 2019 by EBSCO Medical Review Board Elliot M. Levine, MD, FACOG
Last Updated: 11/17/2020

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