HORMONAL TREATMENT
Hormonal treatments can be used on their own or in combination with surgical treatment and/or analgesics, alongside nutritional and lifestyle changes such as exercise, sleep, and pain management, as well as complementary therapies.
It’s important to discuss the various treatments with your doctor to help choose options that best suit your needs. There are advantages and disadvantages to all the types of treatments, and it may take some time and trialling to find the right combination for you. The best treatment combination for you may well change over your lifetime experience of endometriosis.
Endometriosis and adenomyosis respond to reproductive hormones. Hormone therapies aim to therapeutically change the cycle of these hormones to reduce endometriosis deposits and their consequent impact.
Hormone treatments may control symptoms and slow the progression of endometriosis. Options are:
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Progestin-only contraceptives and medications which thin the endometrium are presumed to have a similar effect on endometriosis. They may also directly reduce inflammation.
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Combined Oral Contraceptives control ovulation which may be implicated in the development of endometrioma. Taken continuously – now the recommended method – they can also suppress periods
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GnRH Analogues work by creating a temporary pseudo-menopausal state.
Progestin options
Progestin treatments can be delivered in pill form as well as long-term intra-uterine and implantable devices (IUD and Jadelle). These options can be combined if symptoms are not sufficiently controlled.
Progestin-only contraceptive pill (POP / Minipill)
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Cerazette (which uses the progestin Desogestrel, and suppresses ovulation)
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Microlut (Levonorgestrel)
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Noriday (Norethisterone)
Minipills must be taken at about the same time each day. Generally they suppress periods (amenorrhoea) and will sometimes also suppress ovulation. While not fully funded, Cerazette is often recommended as it is known to suppress ovulation and is also less time-sensitive.
Progestin medications (not contraceptives)
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Primolut (Norethisterone)
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Provera (Medroxyprogesterone acetate)
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Siterone (Cyproterone acetate)
These medications are more usually prescribed for other conditions such as abnormal menstrual bleeding, skin and hair conditions.
Intrauterine devices (IUD)
Originally designed to treat heavy periods for those desiring contraception, Intrauterine Devices are small T-shaped frames made from a pliable plastic which are placed inside the uterus (womb).
The devices contain the progestin Levonorgestrel which is slowly released over a period of time.
As a treatment for endometriosis Mirena typically last for three years and the smaller Jaydess two years (as a contraceptive 5 years and 3 years).
They are commonly fitted by Family Planning Clinics, by some GP’s and may be placed during surgery.
Recent studies have shown that fertility quickly returns after removal.
Implantable device
Jadelle uses the same progestin as the IUD’s (Levonorgestrel) and works similarly, but in the form of a pair of plastic rods inserted beneath the skin – generally on the inside of the upper arm. They have a similar lifetime to Mirena, but those over 60kg may find them less effective over time.
They are commonly fitted by Family Planning Clinics, by some GP’s and may be placed during surgery.
Combined oral contraceptives
Combined oral contraceptives work as a contraceptive by suppressing ovulation, and taken continuously (which is now the recommended regimen) also suppress periods. As well as considerably improving contraception efficacy, continuous usage also significantly reduces side effects such as headaches, bloating and mood swings.
GNRH-Agonists
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Zoladex (Goserelin) - injectable implant
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Lucrin (Leuprorelin) - by injection
GnRH-agonists are synthetic versions of gonadotropin releasing hormone (GnRH), which have a role in controlling the menstrual cycle.
These medications are 'anti-hormonal' so when used continuously essentially create a temporary pseudo-menopausal state. They work by signalling the pituitary gland to stop producing luteinising hormone, which is responsible for stimulating the production of oestrogen from the ovaries.
An ‘add-back’ hormonal medication (HRT) may be recommended to reduce menopausal side effects and the risk of bone loss.
Generally, these therapies aren’t recommended for longer than 6 months, so offer a temporary symptom respite. They may be offered post-surgery, or for those who do not want surgery.