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Managing Endometriosis Treatment: Pharmacists as Key Partners in Patient Care
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Key Takeaways
- Endometriosis involves uterine-like tissue growth outside the uterus, causing severe pain and fertility issues, with diagnosis often delayed due to symptom overlap.
- Treatment options are limited, focusing on surgery, pain management, and hormonal therapies like GnRH-analogues, which aim to manage symptoms rather than cure.
Pharmacists play a vital role in supporting patients with endometriosis through guidance on treatment options and managing side effects.
Endometriosis is a largely misunderstood disease that affects approximately 10% of women and girls of reproductive age around the world. It is incurable with no known cause, and treatment options are often limited to surgery, which is typically used for diagnosis as well. Other treatment options have emerged to help patients manage challenging symptoms associated with endometriosis, including non-steroidal anti-inflammatory drugs, analgesics, and hormonal medicines such as GnRH-analogues. As patients navigate the challenges of endometriosis, including limited treatment options and the current clinical understanding of the condition, pharmacists are uniquely positioned to guide and counsel them.1,2
Outline of a uterus on a woman's torso | Image Credit: © Pixel-Shot - stock.adobe.com
Endometriosis is characterized by the growth of tissue similar to the lining of the uterus to other parts of the body. Existing clinical information about endometriosis had limited its spread to reproductive organs; however, emerging evidence has found it can also affect the bowels, bladder, and lungs. Diagnosing endometriosis can take years because of its symptoms, which can be mistaken for a variety of other conditions. Patients with endometriosis often experience severe chronic pelvic pain, bloating or nausea, fatigue, depression and anxiety, painful periods, as well as heavier bleeding during and between menstrual cycles. Endometriosis can also affect fertility, making it difficult or unlikely for an individual to conceive.1-3
“The degree of pain can be far worse than what any woman should expect with her monthly period, especially since it is a progressive disease, meaning that scar tissue accumulates and the pain worsens over time,” Hugh Taylor, MD, chair of Yale Medicine Obstetrics, Gynecology & Reproductive Sciences, leading endometriosis researcher, said in a Yale Medicine article.1
Treatment options for patients with endometriosis are limited in number, as well as limited in their ability to alter the disease’s trajectory. The aforementioned surgery, painkillers, and hormonal therapies are intended to help manage the pain caused by intense, chronic inflammation. Treatment approaches for endometriosis often consist of a mix of medications and lifestyle modifications—such as a healthy diet—which can help to better manage symptoms.2
Hormonal therapies are at the forefront of treatment for endometriosis, which includes birth control and GnRH-analogues. GnRH-analogues, such as leuprolide acetate for depot suspension (Lupron Depot; Abbvie, Inc), are designed to disrupt production of testosterone and estrogen to induce resolution of endometriosis.4
Leuprolide acetate for depot suspension is an FDA-approved hormonal treatment that has been prescribed by health care professionals since 1990. It is indicated for management of endometriosis, including pain relief and reduction of endometriotic lesions. Leuprolide acetate works by suppressing signals from the pituitary gland to the ovaries to disrupt estrogen production, thereby suppressing the hormones that cause endometriosis to grow. Leuprolide acetate is administered as an injection with 2 different dosing options: a 11.25 mg dose injected every 3 months or a 3.75 mg dose injected once a month over a course of 6 months.4
Pharmacists play a critical role in the management of treatment across various disease states, and the complex, challenging nature of endometriosis treatment requires the kind of care they can provide. Leuprolide acetate for depot suspension is an efficacious, long-standing treatment for endometriosis but does require close monitoring and comprehensive guidance to ensure the safest and most optimal outcome.
Leuprolide acetate for depot suspension demonstrated statistically significant clinical benefit in 2 studies, where 96% of women experienced painful periods after 6 months of injections at the 3.75 mg per month dose. The study also reported relief from pelvic pain (53%), pain during intercourse (56%), decrease in pelvic tenderness (66%), and reduction of hardened endometrial tissue (71%).4
When patients begin leuprolide acetate therapy, they will experience a temporary rise in estrogen levels and worsening of symptoms before the hormonal levels decrease after 1 to 2 weeks. Additionally, patients’ periods will stop during treatment, and any regular continuation of menstruation should be reported and addressed promptly. The accessibility and expertise of pharmacists are especially effective as patients monitor and attempt to interpret their treatment-related symptoms in their everyday lives outside of the clinic.4
Pharmacist counseling female patient about endometriosis treatment | Image Credit: © smolaw11 - stock.adobe.com
Similar to many other therapeutic agents, patients should be aware of potential risks or complications to aid in their treatment decision-making. Pharmacists can counsel patients with endometriosis considering treatment with leuprolide acetate for depot suspension about the potential adverse effects such as hot flashes and sweats, headache or migraine, decreased libido, depression or emotional lability, dizziness, nausea and vomiting, pain, vaginitis, and weight gain. When used alone, leuprolide acetate can cause bone thinning and hot flashes, which can be managed by prescribing Add-back, a daily pill that adds back a small amount of estrogen and/or progestin to manage certain side effects.4
Pharmacists are essential in helping patients navigate the complexities of leuprolide acetate therapy for endometriosis. By offering counseling on potential side effects like hot flashes, headaches, and bone thinning, pharmacists can ensure patients are well-informed and prepared for any changes during treatment. They also play a crucial role in advising patients about managing symptoms, such as recommending Add-back therapy to help reduce the risk of bone loss. With their expertise, pharmacists can support patients in making informed decisions, managing side effects, and adhering to their treatment plan, ultimately improving patient outcomes in the management of endometriosis.
