William Shakespeare clearly had the uterus in mind when he wrote, “Though she be but small, she is wild!”
Your uterus is small – about the size of a clenched fist – but it is a powerful organ that performs many tasks. From protecting human life to regulating the menstrual cycle, the uterus is important for reproductive health and your overall health.
So it’s no surprise that uterine disease can be life-changing – and not in a good way. Conditions such as endometriosis and uterine fibroids can cause heavy bleeding and pain during periods, which can drastically affect quality of life.
Although endometriosis and uterine fibroids are common diseases, we still don’t know much about them and how to treat them. For many women with uterine disorders, hormonal medications are the first line of treatment.
What are hormone therapies for uterine diseases?
Hormone therapies are treatments that regulate estrogen, progesterone and/or testosterone to treat symptoms of uterine disorders.
These medications are not a cure for uterine disorders, but they can play an important role in relieving symptoms, including heavy menstrual bleeding, by thinning the lining of the uterus, controlling the menstrual cycle, and shrinking estrogen-related fibroids.
Birth control pills are usually the first line of treatment for endometriosis and uterine fibroids. However, if birth control pills don’t help with symptoms or you can’t take them for medical reasons, there are other hormonal treatment options for uterine conditions.
Hormonal treatment options for uterine disorders may include:
- Low-dose birth control pills – a combination of estrogen and progestin (a laboratory-made version of the female sex hormone progesterone) or progestin alone, to suppress ovarian function and reduce bleeding or stop your periods altogether
- Method of administration: oral pills
- Examples: norethindrone acetate and ethinyl estradiol (Lo Loestrin Fe); Drospirenone and ethinyl estradiol (Yasmin)
- Gonadotropin-releasing hormone (GnRH) agonists – Block estrogen production to reduce the growth of endometrial tissue and fibroids. They can also reduce bleeding during your period and help with fibroid and endometriosis symptoms.
- Method of administration: nasal spray or injection
- Examples: Leuprolide acetate (Lupron); Goserelin acetate (Zoladex)
- GnRH antagonists — Reduce the amount of reproductive hormones secreted by the pituitary gland to relieve pain and bleeding during your period. They can be used for fibroid and endometriosis symptoms.
- Method of administration: oral tablets
- Examples: Relugolix (Myfembree); Elagolix (Orilissa, Oriahnn)
- Progestogen-releasing intrauterine device (IUD) – continuously releases progestogen to prevent the buildup of the uterine lining, which reduces menstrual bleeding or stops periods altogether
- Method of administration: intrauterine device
- Examples: Levonorgestrel (Kyleena, Liletta, Mirena, Skyla)
- Injections/implants – Delivering longer-term hormones over months or years to suppress estrogen and reduce pain, bleeding, and lesions
- Method of administration: inserted under the skin or by injection
- Examples: Goserelin implant (Zoladex); Medroxyprogesterone acetate implant (Depo-Provera)
- Steroids – Reducing estrogen production to stop menstruation and reduce the growth of estrogen-fed endometrial implants
- Method of administration: oral capsules
- Examples: Danazol (Danocrine); Medroxyprogesterone acetate (Provera)
Benefits and risks of hormonal medications for uterine diseases
As with almost all medications, there are benefits and risks with hormone treatments.
The benefits of hormonal medications may include:
- Stopping or slowing the growth of fibroids
- Prevents the growth of endometriosis tissue
- Reducing heavy bleeding or stopping menstruation
- Regulation of the menstrual cycle
- Pain relief
The risks of hormone therapy may include:
- heart attack
- stroke
- Blood clots
- Breast cancer
- Osteoporosis (bone loss)
Some hormonal medications are taken for short periods of time to improve conditions before surgery – such as shrinking or reducing fibroids or lesions – and to provide symptom relief. For example, GnRH agonists such as leuprolide acetate may be taken for six months – or 12 months if combined with low-dose estrogen or progestin – because symptoms will return after you stop taking the medication and treatment may cause bone loss over time.
Talk to your doctor about hormonal medications
Research shows that hormonal medications can often relieve symptoms and improve quality of life for many women with uterine conditions, although they are not an option for everyone.
It’s important to talk to your gynecologist to find the right treatment for you, especially if you experience pain and/or heavy blood flow during your period.
Here are some tips for talking to your HCP:
- Discuss your treatment goals and what is important to you (preserving fertility, relieving pain, improving quality of life, etc.)
- Determine your priorities for symptom relief, disease progression, or both
- Ask about the side effects of a possible treatment option
- Review your medication history, including previous hormonal medications and their effects on you
- Discuss pain management and what has and hasn’t worked for you in the past
- For each option, request a timeline for symptom relief and disease improvement
The shared decision-making process between you and your HCP can help you get the facts you need to make the best possible decision for your health and quality of life.
This educational resource was created with support from Sumitomo Pharma America, a member of the HealthyWomen Corporate Advisory Council.
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