Facts About Hormone Treatments for Uterine Conditions

William Shakespeare clearly had uterus on the mind when he wrote, "Though she be but little, she is fierce!”

Your uterus is small — about the size of a clenched fist — but it’s a powerful organ that wears many hats. From protecting human life to regulating menstrual cycles, the uterus is important to reproductive health and your health overall.

So, it’s no surprise that having a uterine condition can be life-altering — and not in a good way. Conditions such as endometriosis and uterine fibroids can cause heavy bleeding during your period and pain that can drastically impact quality of life.

Although endometriosis and uterine fibroids are common conditions, we still don’t know a lot about them or how to treat them. For many women with uterine conditions, hormonal drugs are the first line of treatment.

What are hormonal therapies for uterine conditions?

Hormone therapies are treatments that regulate estrogen, progesterone and/or testosterone to treat symptoms of uterine conditions.

These medications are not a cure for uterine conditions, but they can play an important role in relieving symptoms, including heavy menstrual bleeding, by thinning the lining of the uterus, controlling menstrual cycles and shrinking estrogen-fed fibroids.

Birth control pills are usually the first line of treatment for endometriosis and uterine fibroids. But if birth control pills don’t help with symptoms — or you can’t take them for medical reasons — there are other hormonal treatment options to try for uterine conditions.

Hormonal treatment options for uterine conditions can include:

Low-dose birth control pills — a combination of estrogen and progestin (a lab-made version of the female sex hormone progesterone) or just progestin to suppress ovarian function and reduce bleeding or stop your period altogether
- Delivery method: 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 endometrial tissue and fibroid growth. They may also reduce bleeding during your period and help with fibroid and endometriosis symptoms.
- Delivery method: nasal spray or injection
- Examples: leuprolide acetate (Lupron); goserelin acetate (Zoladex)

GnRH antagonists — decrease the amount of reproductive hormones secreted by the pituitary gland to reduce pain and bleeding during your period. They can be used for fibroid and endometriosis symptoms.
- Delivery method: oral tablets
- Examples: relugolix (Myfembree); elagolix (Orilissa, Oriahnn)

Progestin-releasing intrauterine device (IUD) — continuously releases progestin to prevent the lining of the uterus from building up, which reduces menstrual bleeding or stops periods altogether
- Delivery method: intrauterine device
- Examples: levonorgestrel (Kyleena, Liletta, Mirena, Skyla)
Injections/implants — deliver longer-term hormones for months or years to suppress estrogen and reduce pain, bleeding and lesions
- Delivery method: inserted under the skin or via shot
- Examples: goserelin implant (Zoladex); medroxyprogesterone acetate implant (Depo-Provera)

Steroids — decrease estrogen production to stop menstruation and shrink the growth of estrogen-fed endometrial implants
- Delivery method: oral capsules
- Examples: danazol (Danocrine); medroxyprogesterone acetate (Provera)

Benefits and risks of hormonal medications for uterine conditions

Like pretty much all medications, there are benefits and risks to hormone treatments.

The benefits of hormonal medications can include:

Stopping or slowing the growth of fibroids
Preventing endometriosis tissue growth
Reducing heavy bleeding or stopping periods
Regulating menstrual cycles
Reducing pain

The risks of hormonal therapies can include:

Heart attack
Stroke
Blood clots
Breast cancer
Osteoporosis (bone loss)

Some hormonal medications are taken for a short time to help improve conditions before surgery — like shrinking or reducing fibroids or lesions — and provide relief from symptoms. For example, GnRH agonists like leuprolide acetate can be taken for six months — or 12 months when paired with low-dose estrogen or progestin — because symptoms return after you stop taking the medication, and treatment may cause bone loss over time.

Talk to your healthcare provider about hormonal medications

Research shows that hormonal medications are often effective in relieving symptoms and can 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 OB-GYN to find the right treatment for you, especially if you’re having pain and/or heavy flow during your period.

Here are some tips for talking to your HCP:

Discuss your treatment goals and what’s important to you (preserving fertility, reducing pain, improving quality of life, etc.)
Establish your priorities for symptom relief, disease progression or both
Ask about the side effects of any potential treatment option
Go over your medication history, including past hormone medications and how they affect you
Discuss pain management and what's worked and hasn’t worked for you in the past
Ask for a timeline of symptom relief and disease improvement for each option

The shared decision-making process between you and your HCP can help you get the facts you need to make the best decision possible for your health and your quality of life.

This educational resource was created with support from Sumitomo Pharma America, a HealthyWomen Corporate Advisory Council member.

Mary Jane Minkin, M.D.

Jacquelyne Froeber

Senior Editor, HealthyWomen

Jacquelyne Froeber is an award-winning journalist and editor. She holds a BA in journalism from Michigan State University. She is the former editor-in-chief of Celebrated Living magazine and has editing and writing experience for print and online publications, including Health magazine, Coastal Living magazine and AARP.org.

As a breast cancer survivor, Jacquelyne encourages everyone to perform self-exams and get their yearly mammograms.

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