Episode 8: Pros and cons of hormonal treatments for period pain
In this episode of Women of the Well, we take a closer look at hormonal treatments that can help reduce inflammation and ease period pain.
Because with so many options out there – it’s easy to feel unsure about what’s right for your body.
Vera Wellness gynaecologists, Dr Peta Wright and Dr Thea Bowler, guide you through the different hormonal treatments, breaking down the pros and cons so you can make an informed decision that feels right for you.
🎧 Tune in now to discover…
🌿 What causes period pain and ovulation discomfort – Understand how your body works and why some symptoms might feel worse than others.
🌿 Hormonal treatments that could ease the pain – From the pill to IUDs, discover how different options can help reduce inflammation and make your cycle more manageable.
🌿 The pros and cons of hormone-based treatments – While they might work well for pain, some come with side effects like mood swings, weight changes, or even dryness.
🌿 Making the best choice for your body – Dr Peta and Dr Thea talk about why it’s essential to get personalised care so you feel confident in picking the right approach – whether that’s using hormones or trying other methods.
If you’ve ever felt unsure about hormonal treatments, or you just want to get a better handle on managing your cycle – this episode is packed with practical insights to help you make more confident, empowered decisions.
Here’s a list of the hormonal treatments mentioned in this episode:
Oral Contraceptive Pill (OCP)
Contains estrogen and progestin (synthetic progesterone)
Newer pills may include bio-identical estrogen
Progestin-Only Pills
Contains only progestin, not estrogen
Implanon
A progestin-only implant inserted in the arm
Depo-Provera
A progestin-only injection given every three months
Mirena IUD
An intrauterine device that releases progestin locally in the uterus
Kyleena IUD
Similar to the Mirena but smaller, with a lower dose of progestin
Zoladex
A GnRH agonist implant used to suppress ovarian function, leading to a temporary menopausal state
Synarel
A GnRH agonist nasal spray, also used to suppress ovarian function
Ryeqo
A GnRH antagonist tablet containing relugolix, estradiol (estrogen), and progestin, used for managing endometriosis and fibroids
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Episode transcript:
Ep 8 – Hormonal treatments for pain: What you need to know
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[00:01:00] Hi Thea. Hi Peta. We are going to talk today about hormonal treatments that can sometimes help some women to reduce inflammation that can improve period pain and pain during this cycle. Absolutely. I think in previous , episodes, we've talked about the physiology of the menstrual cycle and why, you know, the processes of ovulation and a bleed can cause pain, but to do a really quick recap, ovulation can cause pain because the process of growing our beautiful egg, involves making a follicle, which is like a little cyst around that egg that can get up to about three centimeters in size. And at the time of ovulation, before the cyst wall breaks down or the wall of the follicle breaks down, we make lots of little inflammatory messengers in the pelvis that can irritate the lining of the pelvis.
And then that little follicle opens up to release the egg. And also releases all the beautiful fluid that was housing the egg, giving it lots of growth factors [00:02:00] and, and elements to help the egg grow. And the release of that fluid into the pelvis can also cause a little bit of pain. The other thing around a period, and why that can cause pain is again, because in the lead into the shedding of the lining of the uterus, we make lots of inflammatory mediators, which, can irritate the pelvic nerves.
And then the process of having a bleed. And the shedding of the lining causes little contractions in the uterus. We make a hormone called prostaglandin that causes contractions to shed the lining and shed the blood. And that again is a process that can be like a little tiny labor that causes pain as well.
And so both of those events are entirely normal, but can certainly be painful for some women. They're examples of Inflammation that's serving a purpose in the body and they, and because if you're in a female body, we have ovaries and uterus and those like way more exciting things happening in our pelvis, like two things happening in our pelvis each month, helping us to release an egg to [00:03:00] go pregnant if we want, or to just make our hormones, which is incredibly crazy important part of the health of the whole of our body, they can be painful. And especially if you're someone who has chronic persistent pelvic pain, and you already have a dialed-up nervous system and dialed-up pain pathways, we've already spoken about how In those states, even non-painful things can be perceived by our brain as painful or dangerous and potentially painful events like ovulation and periods can be exacerbated and can be felt as even more painful.
And the nature of women having these inflammatory events in our bodies, it's a repetitive painful stimulus, but some people can be part of that amplification of the, of the pain, um, processing. So some women choose as part of their strategy to help reduce pain in their lives [00:04:00] as well, as well as, and we talk about this as a really important thing, that this isn't just to be used as a band-aid, although for some people if that's where there are They're out in their journey.
That's also totally fine. But ideally, if we can cover all of the bases first and we have the foundational base of the nervous system, our pain pathways, our gut, our immune system, and then if you are wanting to pull in some hormones to suppress or to reduce the inflammation associated with these normal parts of our cycle, that can certainly be helpful to some women.
That's right. And that's what we're going to talk about today. Yeah. So there are lots and lots of different hormonal options to help manage a period. All of them are largely contraceptive. So for people wanting to fall pregnant, we don't usually use these strategies. But we're going to run through all the different options and I guess talk about the pros and cons of them.
As we go. And, also to say that if hormones for you aren't something that you want to, [00:05:00] um, think about or utilize, that's totally fine. Um, it's all about tailoring a bespoke treatment plan. It's just another tool in our toolkit that we can use. That's right. I think, you know, we've done another podcast about managing your cycle without hormone.
And all of the strategies, non-hormonal, getting all of the basics right in terms of pelvic floor and nervous system, as well as utilizing hormones and surgery, um, have to be considered for every patient. And we firmly believe that the patient can choose what's right for them. Exactly. And so if you're going to see a doctor and they're just, they're just offering hormones and you're not comfortable, I think that's, uh, a situation where you might want to, um, either ask about other options or seek other support, um, because it shouldn't be your only option.
Okay. So if we think about one of the most common, uh, hormones that are prescribed, so the pills, the oral contraceptive pill, or OCP as it's sometimes called, that's a pill that [00:06:00] contains, there's all different variations. Some are better than others, I think. different, there are older ones and newer ones.
But in essence, if we think about them all as a generalized category, they contain an oestrogen and a progestin. So both generally synthetic forms of oestrogen and progesterone. Some of the better, newer pills will contain like a bio-identical oestrogen, which are probably the ones that I would usually recommend, but they all contain a synthetic progestin that isn't exactly the same as the progesterone that we make in our body.
The pill's hormones, and usually particularly the progestin part, are in higher amounts than what our ovaries normally make, and what it does is it is a pill that you take every day, and it talks to our brain and tricks our brain into thinking that our ovaries are making those hormones. And so because there's a feedback loop between our brain and our ovaries that are always in constant communication, [00:07:00] our brain's like, oh, Someone else has come into the factory and is making these hormones, so I can have a holiday, and the ovaries can have a holiday.
So we're going to stop talking to each other, we're going to pause this conversation, and that means the signals from the brain to the ovary stop, and that means that the ovary doesn't get the signals to make a follicle and an egg, and it doesn't get the signals to start making estrogen, and it means it essentially turns off our cycle.
So it's really important to understand that. Because, you know, it doesn't regulate hormones, it turns off our hormonal cycle. And instead of having the rise of estrogen in the first part of the cycle, and then the dip just after ovulation, and then the rising of progesterone, and then the dipping of both of the hormones for a period, which happens in a cycle, because we have an egg, we don't have any of that.
We just have flat estrogen, flat progestin. And then in most pills, there's a, um, sugar, [00:08:00] like a four to seven days of sugar pills. And some women will take those and have a withdrawal bleed, but there's no need to do that because it's kind of like, well, the introduction of doing that was basically based on making people feel like it was more natural and there is no need to have that really.
So especially for people who have pain, um, and want to avoid that inflammatory event, we'd often recommend if you're going to be on the pill, You don't need to have a bleed. You can just keep taking the active tablets. And because what that does is that keeps your lining quite thin and stable. And you only have a bleed with a period because of the fall in hormones, which is what happens when you have the sugar tablets.
So it reduces or it stops ovulation and it stops a period. So it can stop both of those inflammatory events. And a lot of women like that and feel good. But what are some of the side effects from the pill? Yeah, I think it's important to consider the downsides. While it does work really well for a huge majority of people, helps [00:09:00] to reduce pain.
A lot of people find skin issues are improved as well. But there are a number of downsides that I think is really important that people are aware of because a lot of times they can be overlooked. And so most of them pertain either to the action of the progestin in the body or the lower levels of oestrogen that occur long term.
So if you imagine a normal menstrual cycle where we make really huge peaks of oestrogen in the process of ovulation, the pill gives us a little bit of oestrogen constantly, but over time, it's far less estrogen in the body than we would make if we were having regular ovulatory cycle. and estrogen is very important for, you know, lots of processes in the body, but particularly for the health of the vulva and vaginal skin.
The skin in the, in the vulva and in the vagina. And one thing that's really common is that people start to notice some pain [00:10:00] when they have sex, or some, even some pain in the vulva at rest when they're not having sex. And that's just due to the lower levels of estrogen and some androgens, um, in those tissues over time.
And so it's really important if you do develop those symptoms that you consider stopping the pill or thinking about other forms of treatment that can help to increase the levels of estrogen in those parts of the body. Kind of like that, when that dryness that menopause. That's right. That level of estrogen and it's not uncommon to see young women who've been on the pill for a long time and they might have had that effect from like the first time they have sex and then they think there's something wrong with them and it's a side effect of this treatment.
Absolutely. Okay. Well, it's not. I just don't think it's as reported as probably as commonly as it actually happens and most women don't recognize the link. And I think as well, a lot of women don't feel comfortable talking about it. It's a little bit taboo, so they probably don't mention it to their GP or a health practitioner that they're talking to.
And it [00:11:00] probably goes on for a really, really long time. Um, and I think Addressing it really quickly is actually important because, um, pain in that part of the body is something that can come on very quickly, but can be really difficult and can take quite a long time to unravel. And especially if you've already got upregulated pain pathways and it's another sensitizing event.
So we have to be careful when we're using something to treat pain that we're not creating more problems. So for many women it's fine, but for some people that can happen. And, um, the other thing that we see really commonly is more related to the progestin element of the pill. Um, and the synthetic progesterone, otherwise termed progestins, for some women can have an irritant effect on the brain.
So it can actually predispose people to feeling anxious or feeling depressed. Um, and that is a really common side effect of the pill. I was also going to say, I think it's also due to the low kind of estrogen levels too, because it's not uncommon for people [00:12:00] to say I felt numb or I didn't feel anything.
Yeah. And well, that Danish study was. A study that was done on lots of Danish women, um, and it showed that there was a slightly higher risk of depression, especially if you're an adolescent starting the pill, but that that risk didn't actually go away when they went off the pill as an adult. But the thing as well is that I'll hear people talk about that study and say the risk was only very slightly increased.
And then there's this whole, you know, and then there's another big study that suggests that the pill has no effect on mood or anxiety and depression, but I'm sorry, I am a woman who's taken the pill and I know that that's not true. Number one, from my personal experience and number two, from every single patient, from many patients that I see who do report that.
Do you see people who, who have been feeling low? Mm. And stop the pill. And they say it's like a cloud lift. Yes. You know, it's like the next day I felt myself again. And of course it's completely [00:13:00] insane to suggest to me that, um, you know, if we're using something that is going to change our hormones and those hormones do have an effect on our brain and our mood that it wouldn't and couldn't cause an issue for some women.
And, um, so I, my, personal philosophy is I always tell people that it's a risk and, um, ask them to be aware of their mood. And I believe every single side effect that anyone has and you know, we can choose something else if that's, um, the case for you and there's never any harm in going off it and seeing if you feel any different.
The other thing that you see fairly commonly is that people will start the pill, their mood will deteriorate, they'll talk to their GP and be put on an antidepressant, um, for that pill antidepressant combination. And I think if you're someone who is in that situation and you think back and you realize, oh yeah, my mood did sort of change after I started the pill, then perhaps thinking about stopping it.
A lot of the time again, we see patients in that situation who, when you stop the pill, they no longer need their antidepressant. [00:14:00] Exactly. So, um, that's something to be aware of. And then there are, I guess, the sort of more longer-term health implications of the pill, um, where there have been shown, due to the synthetic oestrogen to have a slightly higher risk of clotting and stroke.
And that's on a background of something that is incredibly rare in a population of young women. So it does increase, but the numbers are still very low. And that's for any contraceptive pill that contains an oestrogen. That's right. So in the combined pill section, their next forms of pill are progestin only pills.
So they only contain the progestin and not the oestrogen. And I kind of like these less than the combined pill because our brains need oestrogen and some of them can be So Slender is an example of a progestin only pill that is contraceptive, so it turns off ovulation, and um, but it doesn't, [00:15:00] so it's suitable for people, for example, for whom the pill, the combined pill might be contraindicated because of, they might have a high risk of blood clotting, or they might have migraines with aura, which um, is a situation where the combined pill can potentially have a slightly higher risk of things like stroke.
So it turns off ovulation the same way as the combined pill, but it just replaces, has progestin and no oestrogen. So while that can still sometimes be fine for some women, um, for others, you know, I think it can be potentially more likely to cause mood problems because you're not getting the oestrogen in the brain and potentially more, um, you know, vulva vaginal symptoms as well. Sometimes, um, there are tricky ways we can troubleshoot those things by using and it can seem ridiculous because you're treating a side effect of a medication with another medication. But for some people, if they are feeling like it's really helping their pain but they've got side effects, then [00:16:00] adding some estrogen in the form of a gel or a patch can actually help with those side effects. And then thinking about. Implantable. Mm-Hmm. type types of, um, contraceptive. So I just ask you before you go into that, I see a lot of patients who've come, who've already been put on other progestins, like multiple doses of, you know, progestin, like, um, they would be synthetic progestins, but quite high dose progestins and taking multiple tablets a day.
Do you ever recommend that? I think really like if, if you're someone that's struggling with pain, what we should be aiming for is not to have a period, if that's what you want. And once you reach the point of not having a period, adding extra hormone on top of that really serves no purpose.
Except it adds to your risk of side effects. Well, that's right. So really it adds to the risk of weight gain and skin changes and mood changes and. All of the things that we, because there [00:17:00] might be women who are listening to this, who might be put on. So Prevera is a, is a medication that often women are put on if they've had say, for example, a diagnosis of endo.
And they might be on multiple Prevera plus the pill. Well, they often, yes. They often have marinas and pills and progesterone tablets, don't they? Yeah, and things like weight gain, which we didn't mention for the pill, but any of these hormones, you know, can potentially Yeah. Cause weight gain. I always say to my patients, that's right.
Any of the hormonal contraceptives can cause changes in mood, skin, hair, breast, and weight. And every individual is a different mix of hormones and hormone receptors, so two different people can take the same. contraceptive and had quite different, um, experience. That's right. Implantables. Yes. So then I guess thinking about the Implanon and the Depo, which are kind of similar.
Um, the Implanon is a little bar that goes in your arm that lasts for three years. Do you ever use that? No, I don't know. I never use that. I'm [00:18:00] taking them out a lot. Not putting them in. Yeah. And the Depo is an injection that you get in your arm every three months. They're different types of progesterone, but essentially delivering progesterone to the body subcutaneously, again, to switch off ovulation and to cause other changes in the genital tract, that help to prevent pregnancy.
. I very rarely prescribe them because number one, they're, they have all the side effects of, of taking a progesterone only contraceptive, primarily mood being one of them. Um, more weight gain yeah. Skin changes. Um, yeah. But the main side effect of them is that probably 20 to 40 percent of people have sort of random bleeding.
So lots of people will find they have spotting or unscheduled bleeding that, um, that can be very unpredictable. So a lot of people find them just not particularly, you know, easy to manage. Yeah. So while Implanon, for example, [00:19:00] can be a great contraceptive, really, really effective for contraception and last for three years for bleeding.
If you have bleeding as your problem that you're trying to solve, yeah, 40 percent and it does, it can have dysfunctional bleeding. It doesn't get better with time, like for example, the Mirena. So they wouldn't be ones that we would choose. And long term Depo Provera can cause like, you know, over two years of use can increase the risk of things like osteoporosis and bone loss because again, we're suppressing our natural production of estrogen, which we need for our bones, obviously.
So it's really important if you are someone who's on that and it's working for you that you're having regular bone scans and potentially looking at estrogen replacement too. And then we would think about the IUDs, so the progestin containing IUDs, which, to be honest, I would talk about all of these options with my patients, but I think that I feel like even though the IUDs, the intrauterine device is what it stands for, and there are two hormone containing ones, [00:20:00] um, one's called Mirena, and it contains a synthetic progestin.
And the other one's called Kyleena, which it's referred to as like the little sister of the Mirena. It's slightly smaller and has a slightly lower dose of the hormone, but it works very similarly. And often people think that that's more invasive, but I kind of feel like, yes, it's a device that's put inside your uterus, but it actually has more of a local effect rather than turning off your whole reproductive cycle and your hormones.
That's what I was going to say. So can you explain how it differs from the pill? Yeah. So it sits, so it's a little T shaped device and it sits inside the, um, top of the uterus inside the cavity and it releases progestin over time. And I think about estrogen Kind of like fertilizer for the lining of the uterus.
It makes it grow like a thick, beautiful garden and progesterone, which is our natural progesterone hormone that we make after ovulation and progestin. [00:21:00] So those synthetic versions both kind of work in a similar way at the level of the uterus, where it's kind of like. It's like either a lawn mower or a gardener, in my analogy.
And so it trims down that lawn and keeps it nice and thin. So it inhibits the growth of those cells. So if that Mirena is in there with the hormone in the uterus, it's like a little lawn mower mowing the lawn down all the time, keeping the lining thin. Most of the hormone, maybe 90 percent of it stays in the uterus, about 10 percent of it can travel around the rest of the body.
For the first few months of it being in, Some, for some women, the concentration of hormones can be enough that it can suppress ovulation. So stop that conversation between the brain and the ovary. But for most women, over time, it only acts locally. So it's only, if that happens, it's only a temporary effect.
And then it mainly works inside the uterus and it allows the brain and the ovaries to pick up their conversation and keep talking to each other and keep um, ovulating, making an [00:22:00] egg and uh, releasing our beautiful hormones and still having a cycle. So the irony is that with the Mirena, you still have a cycle underlying, but you may not have a bleed.
So because that lining is really thin and that, um, lining is being kept stable by the constant level of hormone in there, it doesn't need to shed. So most women at the 12 month mark, particularly within Mirena, have, um, either have no periods or really, really light periods. But they still have that undergoing cycle, underlying cycle.
Whereas with women who are on the pill, and particularly if they're taking the sugar tablets, they're getting a bleed every month, but they don't have a cycle. So, um, it tends to, I know there is a study, and I think it is the Danish study, that suggests that the Mirena was maybe even worse for mood, actually.
But I don't see that in practice, and I wonder whether some of that is, if it's the first few months of having it [00:23:00] in, and it is reducing the, if it is stopping ovulation for those first few months and we're reducing estrogen, um, that can certainly cause, I feel like that's the time when most people might report a mood change.
And usually if you persevere, that changes. And I find that if you, if I had someone like that, I would test their hormones and if they were still not ovulating then, and they, but they were lacking the effect of the Mirena and no bleeding, then you can add some, um, estrogen topically. And that often helps a lot.
That's my feeling about that. Yeah, I agree. Totally agree. Um, and I would agree with you that I don't really see it cause mood changes very often at all in practice. No. What about like risks and downsides of the moment? So, um, again, any hormone, I say, even if it is a uterus, can cause mood changes, can cause other, um, hormonal skin and hair changes.
So sometimes more acne, particularly at the start. Some people can be very sensitive. Other people have no [00:24:00] problems. Things like breast tenderness, bloating. Um, because it is inserted into the uterus, it can be crampy for a little while. The main side effect is that most women, they have some light, annoying bleeding for the first few months.
And that's because I think about, like, if you're going to mow a big, thick lawn down, and you want it to be as thin as a tennis court, there's going to be, um, lawn clippings that come away. And then by the time it's as thin as a tennis court, there's no more lawn clippings to come. This is my analogy.
It's full of that and garden. Um, and so, um, if you, if most women know that, then they, um, and they know that for most women it improves until it's nothing. And there are lots of ways of troubleshooting it if it's very annoying. Yeah. That's a situation where you might add another Hormone for a time, for a short period of time while it settles in. Things that people Google and get really worried about would be infection or perforating the uterus.
It's really, really uncommon. So infections like less [00:25:00] than one in a thousand and only usually happens if there's a concurrent STI, um, like a sexually transmitted infection. So I'd usually check for that at the time and treat it if it was there. Um, and perforating the uterus or making a hole or putting it in the wrong place.
I've never done that. Touch wood. Um, but it's again, less than about one in 1800 and usually only associated after women have had a baby, like in that very short time after where the uterine wall's a bit inner. If you're going to have it done, you know, you see someone, I always do it with an ultrasound, I check the position afterwards.
So we all know that it's all in the right position and everyone can feel happy. Um, getting it inserted is another thing that people worry about. Most women, if they've been sexually active and they're comfortable, um, or, you know, I wouldn't even just say that if they're using tampons, if they're, um, using other things in the vagina and they're comfortable, then they could have it inserted, you know, in the rooms while they're awake.
If they're comfortable, and I would [00:26:00] offer, you know, pain relief options like usually Panadol, Nurofen and, um, We use the green whistle. So if you've watched Bondi Rescue, they often, if someone's had an accident, they get given that green whistle. Yeah, it's like really dissociating, kind of helps you to feel like a bit nice floaty feeling.
It makes it much nicer. And so you always want to make sure you've got good analgesic options, but it only takes like, when you're in there, 30 seconds, probably less than 30 seconds for the ouchy bit, and it's only ouchy for a second. Um, and the other option is if someone hasn't been sexually active or isn't comfortable for any reason whatsoever, we can do it under general anesthetic, which is a really quick little procedure as well.
Yeah. And I think, like, patients having that option is very important. Yes. Because there are people for whom a, you know, a vaginal examination might be incredibly distressing if they've had a history of sexual trauma or something like that, so, I think if you're not being given that option, asking around until you find someone who does give it to you is [00:27:00] very important.
Yeah, you really need to feel empowered to make the decision. That feels right for you. And that that's happening in a way that's really carefully considered of your situation, your past, and how you're showing up in that moment. So you're feeling really supported. And like, I often have women who come and they might've like seen on Tik TOK, a video of someone having it put in and just actually feel frightened because of that video.
And then we do it. And we at Vera, if someone's having it here, we, you know, essential oils and we have nice music and we have like a dark room and we have a lolly to chew on if someone isn't having the gas. And um, it's just, and then, you know, they're looking at the uterus afterwards, um, the ultrasound and seeing it in there and they're feeling really part of the experience.
I think feeling like you are in control is the most important thing because you hear terrible stories from people where they Clearly we're in pain and we just weren't being listened to, so I think that's the main thing. And the other thing is as well, like [00:28:00] sometimes, especially if you've got, um, and most people with pelvic, with uh, persistent pelvic pain will have some degree of pelvic floor overactivity.
Um, so that muscle tightness, especially if you're having something that feels scary like this, um, If you do have a good pelvic floor physio, working with a physio before we do it and we're so lucky here that we have, sometimes I might get my patients to see Paula or Brooke or Chrissy beforehand, like right before, and they do either like just some beautiful relaxation exercises or visualization.
Like Paula takes my patients through this visualization, we're allowing the Mirena to come in. And I think. That really, really helps. It does, yep. Um, so that's a really, that would be my favourite hormonal option to reduce inflammation. Yep, I agree. I always say to people it's like, it's the gentlest on your body, even though it requires a procedure to put in.
Yes. It's not interfering with anything [00:29:00] else going on. Yep, and you don't have to remember to take something every day. And it's very effective. I was going to say another thing about it. Yep. Some people come to see us and they've had two Mirenas. I actually don't know that there's any evidence for that, whether there are any studies looking at it.
But it's not something that I think is particularly effective. I think. Um, one marina for most women will significantly impact on their bleed. And if it's not, then there are other options, you know, other hormones and things that can be used. Cause we also are doubling the side effect profile because we're adding in more hormone and often like, you know, there can be more cramping associated with having two dividers Well I think that was what I was going to say, like having two marinas in the uterus The uterus always has little tiny contractions around the Mirena, what is this thing?
Particularly in the first little bit after it's gone in, um, and having two in there just makes that much more likely to happen. I personally don't think that it's a particularly and it might [00:30:00] increase more and ovulation so increase the turning off of the brain over conversation to and then the only caveat would be as well.
You know, there would be certain situations where potentially, and especially like one is that I've put into my Mirenas is someone with. Two, uterine horns. Sure. So that means they don't get pregnant in one of them. Two separate sides of the uterus. Yeah, and then, you know, other, potentially other things.
Yeah, but as a rule generally, I don't think there's a benefit for pain. No, no, particularly for pain. And then the last hormone modulating thing, there's, I guess, two sort of versions of this. The first one has been spoken about a little bit more maybe in the media. You might have heard about it for endometriosis.
It's a pill called Ryeqo and it is a GNRH antagonist. I always get confused about antagonists. Yes. And Ryeqo is a GnRH antagonist called [00:31:00] Relugolix. Yes. Why do they have such difficult names? Plus, uh, a natural estrogen, estradiol, and a progestin. Yep. But smaller doses than the pill.
That's right. And I guess the whole thing with this class of drugs, and the other one we're going to talk about is Zoladex, which is a little implant in your belly. But this class of drugs, GnRH antagonists, works to , centrally, so within the brain, switch off the master hormone that talks to the ovary to tell the ovary to start growing an egg.
So rather than using estrogen and progesterone to do that, it works directly in the brain to completely shut down that whole reproductive hormone pathway. And so you can imagine that if you're only using a drug that does that, so totally shuts down all home hormone without, adding any hormone back in, then that is effectively rendering a person reversibly menopausal.
That would be like Zoladex? That's right. So Zoladex, um, Or Synarel? Yeah. Synarel nasal spray and Zoladex is a little implant that you have in the belly, [00:32:00] um, every four weeks. Um, and both of those two used alone will, completely switch off ovulation, completely switch off period, so may help with pain from that point of view, but will cause significant menopausal symptoms.
And so that's often things like hot flushes, headaches, mood changes. It's vaginal dryness and pain and joint pain, fatigue. That's right. And, and long term use without any hormonal add back can increase again, bone loss etc. That's right. So Ryeqo is a newer version of one of those medications that's taken in tablet form with the additional hormone added back in. And it was originally designed to help treat fibroids. So to help treat bleeding associated with fibroids, which are little growths in the uterus that can cause heavy bleeding among other things. But there are more recent studies showing that it's potentially beneficial in reducing menstrual [00:33:00] pain.
But I think that it's not superior to the pill or anything like that. And at this point in time, it's very expensive because it's a newer drug. Very expensive. So people might want to consider it maybe if they've tried all the other things or have endometriosis. I think as well, like the Zoladex thing is important to talk about because, um, lots of patients have the experience of, I guess, perhaps having surgery for endo, perhaps going on the pill and still having pain.
And someone suggesting to them, well, the next thing, and the only other thing you can do is to take the Zoladex. And people often develop quite debilitating side effects from that, um, which can be quite long lasting. Yeah. With the thinking behind it being that, well, if we turn off the hormones that drive ovulation and periods and like estrogen, which, you know, simplistically can increase the growth of endometriosis is the thinking, even though we know that endometriosis is far more complex than that in that it's like a, excessive inflammatory event.
It's got a lot [00:34:00] to do with the immune system. It's not just hormonally mediated. So it's kind of like a very blunt tool to turn off those hormones and some, yeah, I don't, I don't think I hardly ever would use it for endometriosis or pain. And if I was going to be using it, I would be using a hormonal advancer as well.
Definitely giving people additional hormone. And there's no evidence really that it's better than using a myriad of the other options that we've talked about that have far less of an effect on your body. That's right. And I would argue that if you're still having pain after doing surgeries and, and switching off a cycle with the pill that we need to be thinking about other reasons why you might have pain rather than more hormones to further down regulate your own hormones.
Yeah, which can create way more problems. So then looking at the nervous system, the pelvic floor, the gut, the immune system, et cetera. So yeah, it's not something that we would use regularly or routinely at all or recommend for the vast majority of people.
So the main point of this is to understand that [00:35:00] yes, some hormones can be helpful for some women can be part of the tools in your toolkit, but you, whoever you're seeing as your, as your doctor, you want to be able to have a really honest conversation with them about all of this potential side effects and figure out what is right for you. It really needs to be individualized and not prescriptive at all.
Like, like you don't want to see someone who says you have to have this, or you've got endometriosis, so you have to have hormone because there actually isn't evidence. That any of these hormones actually decrease the growth of endometriosis, but there is evidence that they can help with pain and improve quality of life.
So there's a difference there and we can, we can choose to do it or choose to do other things. And you should feel supported in doing what you feel is right for you. Exactly. Okay. Thank you. So, thanks for today. And please, if you have questions, if you like this episode, please, you can check us out on our Instagram, which is verawellness. com. [00:36:00] au. Share it with your friends. If anybody else is getting your life confused about this or want some more information and we will see you next week on Women of the Well.
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This podcast is for information and educational purposes only and is not intended as a substitute for medical advice, diagnosis, or treatment.
