The new endometriosis pain pill might help ease menstrual cramps in some women.
Orilissa, the brand name for elagolix, a new endometriosis drug, made a splash before it even hit the market.
This summer the endometriosis community was excited to hear that the U.S. Food and Drug Administration (FDA) had given approval to Orilissa (elagolix) in the United States for use in treating pain caused by the disease. The first oral gonadotropin-releasing hormone (GnRH) antagonist developed for women with moderate to severe endometriosis pain, the drug is made by AbbVie in partnership with Neurocrine Biosciences.
Orilissa came to market this summer, and it is available in two oral dosages, 150 milligrams (mg) once daily and 200 mg twice daily, taken with or without food. According to AbbVie, the list price is approximately $850 per month.
Endometriosis Pain Has Been Hard to Treat
A chronic disease in which uterine lining tissue grows outside the uterus, endometriosis as yet has no cure; it can only be managed. Women with endometriosis often suffer from severe menstrual pain and heavy bleeding far exceeding normal menstrual discomfort. In fact, endometriosis symptoms frequently escalate to a level that makes daily functioning impossible, according to the Endometriosis Foundation of America.
About 1 in 10 American women of reproductive age are affected by endometriosis, according to the American College of Obstetricians and Gynecologists (ACOG).
Is Orilissa the Answer to Endo Menstrual Pain Relief?
Can this new drug help? The good news: Yes, it can. “Elagolix shuts down the hormonal cycle so you don’t actually have your period. It puts you into a form of menopause so you don’t bleed and the endometriosis lesions don’t proliferate and bleed as well,” says Leena Nathan, MD, an assistant clinical professor at the UCLA Health department of obstetrics and gynecology.
Use of the New Endometriosis Drug May Be Time Limited
The manufacturer is recommending only up to two years of use because of concern about bone loss. Additional studies need to be done to see if it can be safely used for longer amounts of time.
Orilissa vs. Oral Contraceptives for Endo Pain Management
Oral contraceptives, or birth control pills, achieve the same goal: shutting down the menstrual cycle. (Orilissa is not appropriate for women who wish to get pregnant while taking the drug.) And the pill doesn’t carry the threat of bone loss. So why choose Orilissa/elagolix?
“Some patients don’t tolerate contraceptive pills well and want other options. They could try Orilissa and see if they feel differently,” says Dr. Nathan. “In my mind, I would use continuous birth control pills first and if the patient is having breakthrough bleeding or persistent pain, I would then try [the new drug] as a perhaps more effective method.”
Today’s Treatment Options for Women With Endometriosis
She adds, “I think women might start asking for elagolix. I have most of my endometriosis patients on oral contraceptives to suppress the menstrual cycle, but this may be an alternative for women who don’t like or can’t tolerate the contraceptives. For some of those patients, I use Depo Lupron, which is an injectable [treatment for endometriosis pain]. However, that shot can last a month or three months. With Orilissa, patients can take it every day and stop it if they don’t like it. The effects subside pretty quickly.”
Can Orilissa Help Reduce Non-Endo-Related Period Pain?
Although Orilissa may help with menstrual pain that is not related to endometriosis, because it shuts down the menstrual cycle, “I would not use it for that purpose, because it is FDA-approved at this point only for pain related to endometriosis,” says Nathan.
Find the Root Cause of Period Pain and Cramping: The Value of an Endometriosis Diagnosis
If a woman has severe menstrual pain and doesn’t know if it is due to endometriosis, it is important that she get properly diagnosed. Early diagnosis helps with better symptom management. Endometriosis diagnosis can only be done definitively by laparoscopic surgery to look for lesions inside the pelvis and abdomen.
Endometriosis Risk Factors to Watch For
- Family history of endometriosis
- Never gave birth
- Early onset of menstruation
- Later menopause
- Uterine abnormalities
- Short menstrual cycles
- Low body mass
Endometriosis Signs and Symptoms
- Excruciating periods with heavy bleeding
- Pain with sexual intercourse, urination, and bowel movements
- Fertility issues
- Fatigue, diarrhea, constipation, bloating, or nausea, especially during your period
Finding an Endometriosis Specialist for Diagnosis and Treatment
Studies have shown that on average it can take a woman 3 to 11 years from onset of pain symptoms to a diagnosis of endometriosis. Part of the problem is that many physicians, including gynecologists, don’t have special training in endometriosis. If you suspect you have the disease, it is critical that you find a healthcare provider who is knowledgeable and experienced in handling it. Go to Endometriosis Resolved for names of physicians in your area.
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