First-line therapies |
Combined hormonal contraceptives (continuous regimens) | |
Nausea, spotting, headache, mood changes, breast discomfort
| |
Monophasic pill | 1 oral tablet, daily; skip placebo pill | | Low |
Vaginal ring | 1 ring, every 3 wk | | Low |
Transdermal patch | 1 patch, weekly | | Low |
Progestins | |
Acne, spotting, mood changes, headache, weight gain, breast discomfort
| |
Norethindrone | 0.35 mg, 1–3 oral tablets, daily | | Low |
Norethindrone acetate | 5 mg, 0.5–3 oral tablets, daily | | Moderate |
Dienogest | 2 mg, oral, daily | | Moderate |
Medroxyprogesterone acetate | Depot: 150 mg, intramuscular, every 6–8 wk Oral: 10–20 mg/d | | Low |
Progestin subdermal implant | Etonorgestrel 68 mg, implant, every 3 yr | | Low |
Levonorgestrel intrauterine system | 52 mg released over 5 yr or 19.5 mg released over 5 yr |
Spotting, headaches, breast discomfort, functional ovarian cysts May need to be replaced sooner for pain control May not suppress ovulation pain reliably
| Low (amortized over 5 years) |
Second-line therapies |
GnRH agonists | |
Hot flushes, headache, depression, decreased BMD and vaginal dryness Adverse effects minimized with add-back hormone replacement therapy
| |
Leuprolide acetate | 3.75 mg intramuscular, once monthly 11.25 mg intramuscular, every 3 mo | | High |
Nafarelin acetate | 1 nasal spray (200 μg) 2 times/d | | High |
Goserelin acetate | 3.6 mg intramuscular, every mo | | High |
Triptorelin | 3.75 mg intramuscular, every mo | | High |
GnRH antagonists | |
Hot flushes, headache, depression, decreased BMD and vaginal dryness Adverse effects minimized with add-back hormone replacement therapy
| |
Elagolix | 150 mg, oral, daily 200 mg, oral, 2 times/d | | High |
Aromatase inhibitors | |
| |
Letrozole | 2.5 mg, oral, daily | | Moderate |
Anastrozole | 1 mg, oral, daily | | Moderate |