Endometriosis and the Use of Elagolix for Heavy Menstrual Bleeding

Endometriosis and Danazol?

Hello Doctor, the patient is 48 years old and has endometriosis with polycystic ovary syndrome, along with two fibroids measuring approximately 2 cm and 4.9 cm, and a 2 cm cyst.
Symptoms include no dysmenorrhea, but heavy menstrual bleeding occurs each time.
The patient visited a gynecologist due to the heavy menstrual flow that hasn't stopped.
The doctor, possibly due to being busy, only mentioned that the menstruation would eventually end on its own and did not prescribe any hemostatic medication.
Additionally, the doctor mentioned, "You may consider taking Elagolix; please search online for what it is." After researching online, the patient discovered that Elagolix is a new medication targeting endometriosis.
However, most patients online who take it seem to have severe dysmenorrhea associated with their endometriosis, while the patient herself does not experience pain, only heavy bleeding that is difficult to manage.
The patient also experiences significant pain when taking progesterone or birth control pills.
Furthermore, the patient has an aunt with breast cancer.
The patient would like to know if it is appropriate to take Elagolix in her case, where the primary issue is heavy bleeding without dysmenorrhea.
Thank you.

ange, 40~49 year old female. Ask Date: 2019/10/17

Dr. Huang Jianzhong reply Obstetrics and Gynecology

The patient is 48 years old and has endometriosis with polycystic ovary syndrome, along with two fibroids measuring approximately 2 cm and 4.9 cm, and one cyst measuring 2 cm.
Symptoms include heavy menstrual bleeding without dysmenorrhea.
The patient visited a gynecologist due to persistent heavy menstrual flow, but the doctor, possibly due to being busy, only mentioned that the menstruation would eventually stop on its own and did not prescribe any hemostatic medication.
The doctor also mentioned, "You may consider taking Elagolix; please search online for more information." After researching online, the patient discovered that Elagolix is a new medication targeting endometriosis.
However, most online patients taking it seem to have severe dysmenorrhea, while the patient herself does not experience pain but only heavy bleeding that is difficult to manage.
The patient experiences significant pain only when taking progesterone or birth control pills.
Additionally, the patient has a family history of breast cancer (an aunt).
The patient is inquiring whether it is appropriate for someone with heavy bleeding but no pain to take Elagolix.
Answer: A detailed medical evaluation is necessary to provide recommendations; it is advisable to consult a more experienced gynecologist.

Reply Date: 2019/10/17

More Info

Endometriosis is a complex condition where tissue similar to the lining of the uterus grows outside the uterus, leading to a variety of symptoms, including heavy menstrual bleeding, pelvic pain, and infertility. In your case, at 48 years old, with a diagnosis of endometriosis, polycystic ovary syndrome (PCOS), and uterine fibroids, it is understandable that you are experiencing heavy menstrual bleeding without accompanying pain. This situation can be quite distressing and may require careful management.

Elagolix, marketed under the brand name Orilissa, is a medication specifically designed to treat endometriosis-related pain. It works as a GnRH (gonadotropin-releasing hormone) antagonist, which means it reduces the levels of estrogen and progesterone in the body. By lowering these hormone levels, Elagolix can help decrease the growth of endometrial tissue and alleviate symptoms associated with endometriosis, including heavy menstrual bleeding.

While Elagolix is primarily indicated for managing pain associated with endometriosis, it may also help with heavy menstrual bleeding, even in patients who do not experience significant pain. The mechanism by which it reduces bleeding is related to its ability to lower estrogen levels, which can lead to a reduction in the proliferation of endometrial tissue and, consequently, less bleeding during menstruation.
It is important to note that the decision to use Elagolix should be made in consultation with your healthcare provider, considering your specific symptoms and medical history. Since you mentioned that you do not experience significant pain but have heavy bleeding, Elagolix could still be a viable option for you. However, your healthcare provider may also consider other treatments, such as hormonal contraceptives or progestins, which can also help manage heavy menstrual bleeding.

Given your family history of breast cancer, it is crucial to discuss this with your doctor, as certain hormonal treatments may carry risks that need to be evaluated in the context of your personal and family medical history. Your doctor may recommend regular monitoring and possibly alternative treatments that align with your health profile.

In summary, while Elagolix is primarily used for pain management in endometriosis, it may also be beneficial for addressing heavy menstrual bleeding. However, the choice of treatment should be individualized based on your symptoms, medical history, and the potential risks associated with the medication. Open communication with your healthcare provider is essential to ensure that you receive the most appropriate care for your condition.

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