GnRh Summary

Para leerlo en español, clic aquí.

The information on my platforms is educational information only and not medical advice. Always check with your qualified medical professional before making any changes to your treatment plan. Keep in mind that while I strive to share evidenced-based information on endometriosis, this doesn’t always mean that my information is accurate or complete. See my full disclaimer here.

There are 2 kinds of GnRh drugs:

• Agonists like Lupron, Zoladex, Synarel, Prostrap, Decapeptyl, etc.
• Antagonists like Orilissa, Myfembree, Ryeqo, Yselty, etc.

I talk in depth with sources about each on the pages linked above. As I describe on those pages:

• each works differently to lower estrogen, with the antagonists blocking the gland instead of exhausting it like the agonists do
  
  
• the antagonists are newer
  • released to market from 2018 onwards
• the antagonists are often oral
  • meaning you can stop them at any time, vs an injection of the agonist that stays longer in your system
• depending on the dose, the antagonists may not lower estrogen as much as the agonists
  • this may help reduce side effects for some people
  • the lower dose of the antagonists can be taken for 2 years instead of 1 for the agonists

In summary

• GnRh drugs don’t do anything to the endometriosis itself like permanently shrink it or dry it up.
  
  
• Endometriosis can still progress while you’re on GnRh drugs.
  
  
• Various studies comparing GnRh drugs to other hormonal medications show these all to provide similar symptom relief.
  
  
• GnRh drugs are meant to be second-line treatments, prescribed when first-line hormones like contraceptive pills, progestin shots, IUDs, etc are ineffective, not tolerated or contraindicated.
  
  
• GnRh drugs have a higher side effect profile than first-line treatments, and you can’t be on them as long.
  
  
• GnRh agonists are not your only option for symptom management – even if it was presented to you that way.

GnRh drugs are not the only option

GnRh drugs are supposed to be second-line therapies, meaning that they are prescribed when first-line therapies (oral contraceptive pills and progestins) are ineffective, not tolerated or contraindicated. (1) Several studies have shown that in about 2/3 of people with endometriosis, first-line therapies often provide symptom relief.

Yet some doctors put their patients on GnRh drugs immediately and for much longer than the FDA approved time frame. Additionally, various studies comparing GnRh drugs to other hormonal medications* to provide similar symptom relief to patients as GnRh drugs (2).

*such as the Mirena, Dienogest, Depo Provera, combined birth control pills, and others, have shown these other hormones (which a patient can be on for longer and that have a much lower side effect profile)

This is another reason why GnRh drugs are second-line therapies, but unfortunately many gynecologists are giving them out as soon as they suspect endometriosis, without any conversation around the side effects, treatment time limitations, or equally viable options.

Should you take GnRh drugs?

That’s up to you. With any treatment or management option, we should assess if the benefits outweigh the risks. Some helpful questions we can ask are:

• What other options do I have?
  • such as excision surgery, diet and lifestyle changes, other hormonal medications such as the IUD, progestins, and birth controls 
• What options have I already tried?
  
  
• What risks are there to this medication vs the other options?
  
  
• Is my doctor actually knowledgeable in endometriosis?

It can be hard to make choices about our endometriosis care. From the misinformed doctors, to the obstacles of accessing a true specialist, to the daily symptoms which make everything 10 times harder, it can be difficult to gather all the facts to make a fully informed decision. We should be given all the facts and options from the start when we go to the doctor for endometriosis care, but unfortunately that typically doesn’t happen and a heavy burden falls on our shoulders to educate and advocate for ourselves.

Sometimes we judge ourselves for the choices we make about our care, but in reality, these decisions are not easy and we are all doing the best we can.