Table-2 Medications used in the treatment of endometriosis

Drug Dose Adverse effects

Danazol 800 mg per day in 2 divided doses Estrogen deficiency, androgenic side effects

Oral contraceptives 1 pill per day (continuous or cyclic) Headache, nausea, hypertension Medroxyprogeste- 100 mg IM every 2 weeks for 2 months; Weight gain, depression, irregular rone suspension then 200 mg IM every month for 4 menses or amenorrhea months or150 mg IM every 3 months

Medroxyprogesterone 5 to 20 mg orally per day Same as with other oral progestins

Norethindrone

5 mg per day orally for 2 weeks; then Same as with other oral acetate increase by 2.5 mg per day every progestins 2 weeks up to 15 mg per day

Leuprolide 3.75 mg IM every month

for 6 months Decrease in bone density, estrogen deficiency

Gosarelin 3.6 mg SC (in upper abdominal wall) Estrogen deficiency every 28 days

Nafarelin 400 mg per day: 1 spray in 1 nostril Estrogen deficiency, bone density in a.m.;1 spray in other nostril in p.m.; changes, nasal irritation start treatment on day 2 to 4 of menstrual cycle

Common side effects of the hypoestrogenic state include hot flashes, vaginal dryness, decreased libido, insomnia, breast tenderness, depression, headaches, and transient menstruation. In addition, GnRH analog treatment for the recommended six month period causes loss in bone density and total body calcium. GnRH analogs are effective in reducing the size of endometriotic implants following treatment. The recurrence rate over five years ranges from 37 percent in patients with mild disease to 74 percent in those with severe disease. GnRH analogs are as effective as other medical therapy in relieving pain symptoms, but, similar to other drug treatments, they do not enhance fertility.

Oral Contraceptive Pills

Oral contraceptive pills (OCPs) suppress LH and FSH and prevent ovulation. They also have direct effects on endometrial tissue.