Menopause Injection For Endometriosis and Fibroids: What to Know

Menopause Injection For Endometriosis and Fibroids: What to Know

When people talk about a "menopause injection" for endometriosis or fibroids, they usually mean a class of medicines called gonadotropin-releasing hormone (GnRH) agonists. These injections temporarily lower estrogen and progesterone to create a reversible, medication-induced menopause. For many, that hormonal quiet-time can ease endometriosis pain, reduce heavy bleeding, and shrink fibroids enough to improve symptoms or make surgery safer. Here’s a clear, evidence-based look at how these injections work, who may benefit, and what to expect.

What is the "menopause injection"?

GnRH agonist shots (most commonly leuprolide acetate, goserelin, or triptorelin) act on the pituitary gland. After a brief “flare” of hormone signaling in the first 1–2 weeks, they downregulate the system that tells the ovaries to make estrogen. The result is a rapid, reversible drop in estrogen and progesterone—similar to menopause—followed by decreased bleeding and pain in estrogen-sensitive conditions.

Which medications and typical schedules

  • Leuprolide acetate depot: usually given monthly (3.75 mg) or every 3 months (11.25 mg).
  • Goserelin implant: typically every 28 days (3.6 mg) or every 12 weeks (10.8 mg), placed under the skin.
  • Triptorelin depot: commonly every 4 weeks (3.75 mg).

Your clinician will choose a product and schedule based on your diagnosis and goals. Injections are done in a clinic or, for some formulations, at home after training.

How do these injections help?

Endometriosis

By suppressing ovarian hormones, GnRH agonists can reduce inflammation and nerve sensitization associated with endometriosis. Many patients notice less pelvic pain, painful periods, and pain with sex after 4–8 weeks. The FDA approves leuprolide depot for up to 6 months for endometriosis; a second 6‑month course may be considered with “add‑back” therapy to protect bone health and reduce side effects.

Uterine fibroids (leiomyomas)

For fibroids, the shots can reduce heavy menstrual bleeding and shrink the uterus and fibroids, often within 2–3 months. This can correct anemia and make procedures like myomectomy or hysterectomy easier. The FDA approves certain leuprolide depot regimens for preoperative management of anemia due to fibroid-related bleeding, typically as a 3‑month course alongside iron therapy.

Benefits and limits

Pros include substantial relief from bleeding and pain, improved hemoglobin, smaller fibroids and uterine size before surgery, and a non-surgical option while you decide on longer-term plans. Limits include that benefits often wane after stopping (endometriosis symptoms may return; fibroids commonly regrow), and treatment duration is intentionally limited because low estrogen can affect bone density.

Side effects, safety, and add-back therapy

Common side effects mirror menopause: hot flashes, night sweats, sleep disturbance, headaches, mood changes, vaginal dryness, decreased libido, and joint aches. There can be injection-site reactions. Because GnRH agonists cause a brief hormone "flare" at the start, some people notice transient worsening of pain or bleeding in the first 1–2 weeks.

Bone health and add-back therapy

Low estrogen can reduce bone mineral density. To mitigate this, clinicians often prescribe add-back therapy (usually low-dose progestin or combined low-dose estrogen/progestin such as norethindrone acetate alone or with estradiol). Add-back helps control hot flashes, protects bone, and allows longer courses in selected patients. Calcium and vitamin D intake, weight-bearing exercise, and—if treatment is prolonged—periodic bone density monitoring may be advised.

Fertility, pregnancy, and contraception

GnRH agonists are not contraceptives. Ovulation is unlikely once suppression is established, but pregnancy can occur—especially early on—so nonhormonal contraception (e.g., condoms or a copper IUD) is recommended during therapy and for several weeks after stopping. Do not use these medicines during pregnancy; a pregnancy test is typically done before the first injection. Menstrual periods usually return within 4–10 weeks after the last dose, and fertility generally resumes, though underlying conditions still matter.

Who may be a good candidate?

You might discuss GnRH agonist injections if you:

  • Have moderate-to-severe endometriosis pain not controlled with NSAIDs or first-line hormonal options.
  • Need to correct anemia or shrink fibroids before a planned surgery.
  • Prefer a time-limited, reversible non-surgical approach while considering longer-term strategies.

These injections may not be appropriate if you are pregnant or breastfeeding, have undiagnosed abnormal uterine bleeding, have significant osteoporosis or major risk factors for bone loss, or cannot tolerate menopausal symptoms. Your clinician will review medical history, medications, and risks to individualize the decision.

Alternatives if shots aren’t right for you

  • Combined hormonal contraceptives (pill, patch, ring) or progestin-only methods (pills, DMPA injection, levonorgestrel IUD) to lessen bleeding and pain.
  • Nonhormonal options for bleeding (tranexamic acid) and pain (NSAIDs).
  • Oral GnRH antagonists with built-in add-back: FDA-approved combinations for heavy bleeding from fibroids (relugolix/estradiol/norethindrone acetate; elagolix/estradiol/norethindrone acetate) and for endometriosis pain (elagolix; relugolix combination approved for endometriosis pain). These do not cause an initial flare and are taken by mouth.
  • Procedures: for endometriosis, laparoscopic excision/ablation; for fibroids, myomectomy, uterine artery embolization, radiofrequency ablation, MRI-guided focused ultrasound, or hysterectomy, depending on goals and fertility plans.

Practical considerations: access, monitoring, and cost

Symptom improvement typically begins after 4–8 weeks. Follow-up visits monitor side effects, mood, bone health if longer courses are used, and anemia recovery. Insurers often require prior authorization; coverage varies by product and indication. Ask about manufacturer patient assistance programs and whether clinic-administered versus pharmacy-dispensed options affect your out-of-pocket costs.

What to ask your clinician

  • Is a GnRH agonist injection the best next step for my specific goals (pain control, bleeding control, preoperative preparation)?
  • Which product and dosing schedule would you recommend, and for how long?
  • Will I use add-back therapy, and when will it start?
  • How will we protect my bone health and monitor side effects?
  • What contraception should I use during treatment?
  • What alternatives should I consider if I don’t tolerate injections or if symptoms return?

Trusted sources and further reading

Bottom line: GnRH agonist injections can offer meaningful, time-limited relief for endometriosis and fibroids, especially to calm symptoms quickly or prepare for surgery. With careful selection, add-back therapy, and monitoring, many patients find them a valuable part of a broader, personalized treatment plan.

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