Table 2:

Hormonal therapies for endometriosis

MedicationDosageAdverse effects and special considerationsRelative cost
First-line therapies
Combined hormonal contraceptives (continuous regimens)

  • Nausea, spotting, headache, mood changes, breast discomfort

 Monophasic pill1 oral tablet, daily; skip placebo pillLow
 Vaginal ring1 ring, every 3 wkLow
 Transdermal patch1 patch, weeklyLow
Progestins

  • Acne, spotting, mood changes, headache, weight gain, breast discomfort

 Norethindrone0.35 mg, 1–3 oral tablets, dailyLow
 Norethindrone acetate5 mg, 0.5–3 oral tablets, dailyModerate
 Dienogest2 mg, oral, dailyModerate
 Medroxyprogesterone acetateDepot: 150 mg, intramuscular, every 6–8 wk
Oral: 10–20 mg/d		Low
 Progestin subdermal implantEtonorgestrel 68 mg, implant, every 3 yrLow
 Levonorgestrel intrauterine system52 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 acetate3.75 mg intramuscular, once monthly
11.25 mg intramuscular, every 3 mo		High
 Nafarelin acetate1 nasal spray (200 μg) 2 times/dHigh
 Goserelin acetate3.6 mg intramuscular, every moHigh
 Triptorelin3.75 mg intramuscular, every moHigh
GnRH antagonists

  • Hot flushes, headache, depression, decreased BMD and vaginal dryness

  • Adverse effects minimized with add-back hormone replacement therapy

 Elagolix150 mg, oral, daily
200 mg, oral, 2 times/d		High
Aromatase inhibitors

  • Hot flushes, decrease BMD and headaches

  • Used in combination with other medication

 Letrozole2.5 mg, oral, dailyModerate
 Anastrozole1 mg, oral, dailyModerate

  • Note: BMD = bone mineral density, GnRH = gonadotropin-releasing hormone.