Lupron (Leuprolide) for Endometriosis: Efficacy, Regimens, and Side Effects

Leuprolide acetate is a GnRH agonist that initially stimulates then suppresses pituitary gonadotropins, creating a hypoestrogenic state.

Efficacy

• Reduces endometrial implant size and pelvic pain (dysmenorrhea, dyspareunia, chronic pelvic pain).
• Improves fertility post-treatment (limited duration).
• Comparable to danazol, progestins; better side effect profile than danazol.

Regimens

• Monthly IM depot (3.75 mg): Most common.
• 3-month depot (11.25 mg): Improved adherence.
• Daily nasal spray (nafarelin) or SC injection: Alternative.

Typical course: 3–6 months. "Add-back" therapy (norethindrone ± low-dose estrogen) reduces bone loss and hypoestrogenic symptoms without compromising efficacy.

Side Effects

• Vasomotor: hot flashes, night sweats.
• Vaginal dryness, dyspareunia.
• Mood changes, decreased libido.
• Bone mineral density loss (reversible with add-back; limit to 6 months without).

Contraindications

Pregnancy, undiagnosed vaginal bleeding, hypersensitivity. Bone density monitoring if extended use.