Many people find the side effects of GnRh medications to be intolerable.

GnRh Antagonists

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Remember, the information on my website, podcast, Instagram, and any other ways I communicate and/or produce content is educational information only and not medical advice. Always check with your qualified medical professional before making any changes to your treatment plan for endometriosis or any other health problems. See my full disclaimer here.

Names of GnRh antagonists

Some new medications have been introduced onto the market in the past few years:

  • 2018 – Orilissa by Abbvie: generic name elagolix
  • 2022 – MyFembree / Ryeqo by Myovant/Pfizer: generic name relugolix (this also has “add back therapy” in the form of estradiol and norethindrone acetate)
  • 2022 – Yselty by ObsEva: generic name linzagolix

Important: this page is about GnRh antagonists. This is not the same as GnRh agonists, like Lupron, Zoladex, Synarel, Prostrap, etc.

GnRh antagonists are symptom management only

GnRh antagonists are pills that lower estrogen by affecting the way your brain talks to your ovaries on the hypothalamus – pituitary – gonadal axis. The medications block the production of ovarian-stimulating hormones by competitively binding to the GnRh receptors. The medications block the receptor, therefore “competing” with the natural GnRh so it cannot bind with the receptor as it normally would. In turn, this reduces the release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), therefore reducing estrogen and progesterone. However, endometriosis can continue making its own estrogen locally via the aromatase enzyme, which makes estrogen a different way than the ovaries do.
 
GnRh drugs are commonly prescribed by misinformed doctors as a treatment for endometriosis. However, they cannot diagnose, treat, remove, or shrink endometriosis lesions. What they may do is provide symptom management only (although many patients find the drug side effects intolerable). 

GnRh antagonists can have serious side effects

On the prescribing information (and official website) for GnRh antagonists, there’s typically a long list of potential side effects including suicidal thoughts or actions, bone mineral density loss, abnormal liver scans, hot flashes and night sweats, headache, nausea, difficulty sleeping, absence of periods, anxiety, joint pain, depression, and mood changes.
 
Orilissa has been approved by the FDA for the management of endometriosis symptoms for 6 months on the higher dose and 2 years on the lower dose. Myfembree and Ryeqo are also only approved for 2 years. This is due to the risk for bone loss on this drugs. You should speak to your doctor about having a bone density scan to periodically check your bone density.
 

In summary and more information

GnRh medications are not your only option. See my GnRh summary.

Resources

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