Endometriosis - Lifestyle Changes

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Side Effects and Complications. Common side effects (which can be severe in some women) include menopause-like symptoms, including hot flashes, night sweats, vaginal dryness, weight change, and depression. The side effects vary in intensity depending on the GnRH agonist. They may be more intense with leuprolide and persist after the drug has been stopped.

The most important concern is possible osteoporosis from estrogen loss. [For more information, see In-Depth Report #18: Osteoporosis.] To help protect the bones, doctors prescribe “add-back therapy,” with a supplement of combination estrogen-progestin. Because of estrogen loss side effects, doctors generally recommend that women not take GnRH agonists for more than 6 months.

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GnRH treatments can increase the risk for birth defects. Women who are taking GnRH agonists should use non-hormonal birth control methods, such as the diaphragm, cervical cap, or condoms while on the treatments.

Other Drug Treatments

Danazol. Danazol (Danocrine) is a synthetic drug that resembles a male hormone (androgen). It suppresses the pathway leading to ovulation. Many women stop taking this drug because of its adverse side effects, which include bloating, acne, irregular vaginal bleeding, and muscle cramps. Danazol can also cause male characteristics, such as growth of facial hair, reduced breasts, and deepening of the voice. Because GnRh agonists cause far fewer side effects, danazol is rarely used these days for endometriosis treatment.

Aromatase Inhibitors. Aromatase inhibitors are drugs used for breast cancer treatment. They include anastrazole (Armidex), exemestane (Aromasin), and letrozole (Femara). These drugs block aromatase, an enzyme that is a major source of estrogen. Although aromatase inhibitors are not approved for treatment of endometriosis, they are sometimes prescribed “off-label” in doses lower than those used for breast cancer for relief of severe pelvic pain. These drugs can increase the risk for osteoporosis and can cause hot flashes. [For more information, see In-Depth Report #06: Breast cancer.]

Review Date: 07/26/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).