Endometriosis - Lifestyle Changes

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Specific Progestins. Progestins are available in various forms. They include:

• Intrauterine Device. The levonorgestrel-releasing intrauterine system, or LNG-IUS (Mirena) has proved effective for treating heavy menstrual bleeding (menorrhagia), and studies indicate that it helps control the symptoms of minimal-to-moderate endometriosis pain. Progestin released by the IUD mainly affects the uterus and cervix and causes fewer widespread side effects than other forms of progestins. Studies indicate that the LNG-IUS works as well as gonadotropin releasing hormone agonists in managing endometriosis pain, and causes less loss of estrogen.
• Injection. Medroxyprogesterone (Depo-Provera, also known as DMPA) is administered by injection every 3 months. (A low-dose formulation is called Depo-subQ Provera 104.) Depo-Provera can cause loss of bone mineral density, a condition associated with osteoporosis, but GnRH agonists may cause even more bone thinning. Depo-Provera can cause persistent infertility for up to 22 months after the last injection.
• Pill. Oral progestins include medroxyprogesterone (Provera) and norethindrone (Micronor, Aygestin, Norlutate). Norethindrone is also known as norethisterone.

Click the icon to see an image of an IUD.

Side Effects of Progestins. Side effects of progestin occur in both the combination oral contraceptives and any contraceptive that uses only progestin, although they may be less or more severe depending on the form and dosage of the contraceptive. The most common side effects include:

• Changes in uterine bleeding, such as higher amounts during periods, spotting and bleeding between periods (called break-through bleeding), or absence of periods
• Weight gain
• Water retention and swelling in the face, ankles, or feet
• Breast tenderness
• Headaches
• Nausea
• Mood changes

[For more information, see In-Depth Report #91: Birth control options for women.]

GnRH Agonists

Gonadotropin releasing hormone (GnRH) agonists are effective hormone treatments for endometriosis. They block the release of the reproductive hormones LH (luteinizing hormone) and FSH (follicular-stimulating hormone). As a result, the ovaries stop ovulating and no longer produce estrogen. Ovulation and menstruation resume around 4 - 10 weeks after stopping the drug. The specific length of time depends on the type of GnRH agonist used.

Specific GnRH Agonists. GnRH agonists include the implant goserelin (Zoladex), a monthly injection of leuprolide (Lupron), the nasal spray nafarelin (Synarel), and buserelin (Suprefact), which is given either as a nasal spray or injection.