From the Guidelines
Endometriosis treatment should prioritize a combination of pain management, hormonal therapies, and sometimes surgery, with the goal of improving quality of life and reducing morbidity and mortality. The treatment options for endometriosis can be categorized into:
- Pain management using nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg every 6-8 hours) or naproxen (500mg twice daily) as first-line options 1
- Hormonal treatments aiming to suppress estrogen production, which fuels endometriosis growth, including:
- Combined hormonal contraceptives (pills, patches, or rings) used continuously to prevent menstruation
- Progestins like norethindrone acetate (5-15mg daily), medroxyprogesterone acetate (30-100mg daily), or the levonorgestrel IUD providing symptom relief for many patients
- GnRH agonists such as leuprolide (3.75mg monthly injection) or GnRH antagonists like elagolix (150mg daily or 200mg twice daily) effectively suppressing estrogen but should be limited to 6-24 months due to bone density concerns and may require add-back therapy with low-dose estrogen and progestin 1
- Surgery, including laparoscopic surgery to remove endometriotic lesions, which may be necessary for severe cases or when fertility is desired 1 It is essential to individualize treatment based on symptom severity, fertility desires, side effect profiles, and patient preferences, and to consider lifestyle modifications such as regular exercise, stress management, and anti-inflammatory diets to provide additional symptom relief alongside medical therapy 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Therapy with norethindrone acetate tablets must be adapted to the specific indications and therapeutic response of the individual patient. ... Endometriosis Initial daily dosage of 5 mg norethindrone acetate tablets for two weeks. Dosage should be increased by 2. 5 mg per day every two weeks until 15 mg per day of norethindrone acetate tablets is reached. INDICATIONS AND USAGE Norethindrone Acetate Tablets, USP are indicated for the treatment of secondary amenorrhea, endometriosis, and abnormal uterine bleeding due to hormonal imbalance in the absence of organic pathology, such as submucous fibroids or uterine cancer.
The treatment option for endometriosis is norethindrone acetate tablets, with an initial daily dosage of 5 mg for two weeks, increasing by 2.5 mg per day every two weeks until 15 mg per day is reached, as needed and as tolerated 2. Norethindrone acetate tablets are indicated for the treatment of endometriosis 2.
From the Research
Treatment Options for Endometriosis
- Medical therapy is often the first line of management for women with endometriosis to ameliorate symptoms or prevent post-surgical disease recurrence 3
- The primary goal of medical treatment for endometriosis is to halt the growth and activity of endometriosis lesions 4
Hormonal Therapies
- Combined hormonal contraceptives and progestins are currently available first-line treatments for endometriosis, and are efficacious and well tolerated for treating disease-related pain 5
- Progestins are considered the first-line treatment, highly effective, and with reduced side effects 6
- Gonadotropin-releasing hormone (GnRH) agonists and antagonists, such as elagolix, have demonstrated promising results in treating endometriosis-related pain 5, 3
- Aromatase inhibitors (AIs) have shown potential in treating endometriosis, but their long-term efficacy and safety are still being researched 5, 4, 3
Non-Hormonal Therapies
- Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used in the treatment of chronic inflammatory conditions, and are efficacious in relieving primary dysmenorrhea 3
- Other non-hormonal therapies, such as danazol, are available but have limited use due to their side effects and the availability of better-tolerated hormonal drugs 3
Emerging Therapies
- New drugs with innovative targets have been identified, but most of these compounds have only been evaluated in pre-clinical studies or early clinical trials 5
- Further extensive clinical research is necessary to better elucidate the pharmacologic characteristics, efficacy, and safety of these emerging therapies for the treatment of endometriosis 5