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Hormonal Therapy

Questions about hormonal medications commonly used for endometriosis — birth control, GnRH agonists, progestins, and more.

What are the differences between the hormonal therapy options for endometriosis?

Why it matters

There are many hormonal options — combined oral contraceptives, progestins (dienogest, norethindrone), GnRH agonists (Lupron), GnRH antagonists (Orilissa) — and they work differently with different side effect profiles.

Conversation guide

You might hear

I'm going to put you on Lupron.

A good follow-up

Before we proceed, could you explain why Lupron over other options? What are the expected side effects, and is there add-back therapy to manage them? What's the planned duration of treatment?

Why this works: GnRH agonists like Lupron create a temporary menopause-like state. They can be very effective but have significant side effects including hot flashes, bone density loss, and mood changes. Add-back therapy (low-dose hormones) can mitigate some side effects. Duration is typically limited to 6-12 months.

Tips

Ask about the duration of treatment — some hormonal therapies have limits on how long they should be used
Ask about side effects AND what can be done to manage them

How long should I try this hormonal treatment before we know if it's working?

Why it matters

Some treatments take time to show results, but you shouldn't wait indefinitely. Having a clear timeline prevents months of suffering on an ineffective regimen.

Conversation guide

You might hear

Give it 6 months.

A good follow-up

Can we check in at the 3-month mark? I'd like to assess whether it's trending in the right direction rather than waiting the full 6 months if there's no improvement at all.

Why this works: Most hormonal treatments should show some benefit within 2-3 months. If there's zero improvement by then, waiting longer is unlikely to help. An interim check-in is reasonable.

What happens when I stop this hormonal treatment?

Why it matters

Understanding whether benefits persist after stopping treatment helps with long-term planning, especially around fertility goals.

Conversation guide

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Symptoms usually come back when you stop.

A good follow-up

If symptoms return after stopping, does that mean the underlying disease is still progressing while I'm on treatment? How does this affect my long-term treatment plan?

Why this works: Most hormonal treatments suppress symptoms but don't eliminate endometriosis. Understanding this helps you weigh long-term hormonal management versus surgical treatment.

Could this medication affect my bone density?

Why it matters

Some endometriosis medications — particularly GnRH agonists and long-term depot medroxyprogesterone (Depo-Provera) — can affect bone density, especially in younger patients.

Conversation guide

You might hear

Short-term use is fine for your bones.

A good follow-up

Should we get a baseline DEXA scan, especially if there's a chance I'll need this treatment long-term or might need to repeat it later?

Why this works: Baseline bone density measurement provides a reference point. This is especially important for patients who may go through multiple rounds of GnRH treatment or who have other risk factors for osteoporosis.

Tips

Ask about add-back therapy if you're prescribed a GnRH agonist like Lupron
Calcium and vitamin D supplementation may be recommended during treatment

I'm struggling with the side effects. Can we adjust the treatment?

Why it matters

Side effects are the #1 reason patients discontinue treatment. There are often adjustments or alternatives that can help.

Conversation guide

You might hear

Just give it more time — the side effects usually settle down.

A good follow-up

How long would you expect these specific side effects to improve? If they don't improve by that point, what would be our next option?

Why this works: Some side effects do improve with time (e.g., breakthrough bleeding on progestins often decreases after 3 months). Others (mood changes, low libido) may not. Knowing the difference helps you decide whether to persist.

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