gnrh analogues injections for the treatment of pelvic pain

GnRH Analogues Injectionsfor the Treatment of Pelvic Pain & Fibroids (Decapeptyl / Zoladex)

Obstetrics & Gynaecology

patientinformation

Hearing about your experience of our services is very important as it means we can pass compliments on to our staff and make improvements where necessary. Tell us what you think by emailing us at: [email protected]

If you require this document in another language, large print, braille, audio or easyread format, please ask our healthcare providers*

*Note to healthcare providers: Translated / easyread healthcare information can be sourced via the Easyread websites listed at the back of this leaflet or via contacting our translation service which can be accessed through the Hub.

Bring your medicines when you come into hospitalPrescription medicines

Medicines you have bought

Alternative & herbal medicines

Inhalers

IntroductionGnRH analogues / agonistsIt has been suggested that you have a treatment called a gonadotrophin-releasing hormone analogue (or agonist).

Examples include Decapeptyl (triptorelin acetate), Zoladex (gosarelin acetate) and Prostap (leuprorelin acetate).

This information leaflet tells you about this particular group of drugs and why they are used.

What are GnRH analogues used for?GnRH is a hormone produced naturally by your body.

GnRH analogues are designed to ‘turn off’ the ovaries temporarily and create a temporary ‘menopausal’ state. This is done by blocking the hormones that stimulate the ovaries.

This results in a low level of the female hormone oestrogen, which will go back to normal when the treatment is stopped.

GnRH Analogues Injections for the Treatment of Pelvic Pain & Fibroids (Decapeptyl / Zoladex)

3


There are several reasons why you might have been recommended this treatment, including:

l To reduce / suppress pain caused by conditions that are sensitive to the hormones of the menstrual cycle, including endometriosis and adenomyosis.

l As a diagnostic test to see if pain is ‘cyclical’ or related to hormones of the menstrual cycle. If pain improves when the ovaries are ‘turned off’, it gives us a better idea of how to treat the pain.

l To reduce the size of fibroids (common and benign growth found in the uterus) which often cause heavy periods and abdominal pain. Stopping GnRH analogues can cause the fibroids to grow again. GnRH analogues can be used before surgery to make fibroids smaller and easier to remove.

l Prior to surgery to remove the ovaries. If the pain does not improve with GnRH analogues, it is unlikely that removing the ovaries will be helpful.

4


How do I take GnRH analogues?GnRH analogues are typically given as an injection into one of the buttocks or a muscle of the thigh.

This can be a one-off injection or a course of injections (for example, once a month for 6 months).

It is also available as nasal spray.

How long can I stay on GnRH analogues for?Currently, GnRH analogues are not licensed for use beyond 6 months. This is because of concerns around thinning of the bones. Under certain circumstances, a Consultant Gynaecologist can sometimes agree to a more prolonged course of treatment (up to 12 months or more). However, you must be made aware of the risks of doing so and you should be advised to have bone scans along with hormone replacement therapy (HRT).

HRT is given with GnRH analogues to help reduce the bone-thinning effects of the injections. It is especially important if treatment continues beyond 6 months. HRT can also help to reduce other side effects associated with these injections, such as hot flushes, sleep disturbance and mood swings.

5


Are there any other risks or side effects with GnRH analogues?As with most medications, GnRH analogues may produce other unwanted side effects which may include:

l Hot flushes l Mood disturbancel Vaginal drynessl Loss of interest in sex (loss of libido)l Increased ‘bad’ cholesterol and reduced ‘good’ cholesteroll Altered sleep / Insomnial Weight changesl Headachesl Occasionally hair lossl Changes to your eyesightl Soreness at the site of injection

The side effects associated with GnRH analogues are reversible and will stop when the treatment ends.

A single injection usually lasts about 4 weeks only (although a slow-release version exists which can last up to 12 weeks).

After the 3mg (4-week) injection, it can take up to 2-3 months for your periods to return.

6


Changes to your eyesight may affect your driving so make sure you are safe to drive or perform other activities that might otherwise be dangerous if you could not see properly. If your eyesight is affected by GnRH analogues, it will return to normal after stopping treatment.

Allergic reactions to GnRH analogues are very uncommon, however, if you experience any of the following please contact your doctor immediately:

l Itchingl Skin rashl Shortness of breathl Chest pain

What sort of contraception can I use? It is important that you use adequate contraceptive precautions whilst on this treatment. You will need to use a barrier method of contraception, for example, condoms or a diaphragm whilst having this treatment. You should not take the oral contraceptive pill.

If you have any further questions you can contact us in the Gynaecology Clinic at Greenoaks (01709 427641).

7


References1. Brown J, Pan A, Hart RJ. Gonadotrophin-releasing hormone analogues

for pain associated with endometriosis. Cochrane Database of Systematic Reviews 2010, Issue 12. Art. No.: CD008475. DOI: 10.1002/14651858. CD008475.pub2

2. Ipsen. Decapeptyl SR 3mg powder for suspension for injection. Summary of Product Characteristics. 2017. http://www.medicines.org.uk/emc/medicine/868

3. Dunselman GA, Vermeulen N, Becker C, Calhaz-Jorge C, D’Hooghe T, De Bie B, et al. ESHRE guideline: management of women with endometriosis. Human Reproduction 2014; 29:400–12.

4. Abu Hashim H. Gonadotrophin-releasing hormone analogues and endometriosis: current strategies and new insights. Gynecological Endocrinology. 28(4):314-21, 2012. http://www.ncbi.nlm.nih.gov/pubmed/22303840

BP at time of first injection: / mmHg First injection given in clinic on:

Next injection due (usually with GP) on:

PRESCRIPTION CHARGES APPLY AT YOUR GP SURGERY

8


Notes

9

10

Produced by Mr R Faraj and Dr W Smith (ST5), September 2017. April 2014, April 2020. Revised April 2020. Revision due April 2023. Version:2.0©The Rotherham NHS Foundation Trust 2020. All rights reserved.

How to contact usGreenoaks Telephone 01709 427641

SwitchboardTelephone 01709 820000

Useful contact numbersIf it’s not an emergency, please consider using a Pharmacy or call NHS 111 before going to A&E.

NHS 111 Service Telephone 111

Stop Smoking Service Telephone 01709 422444

A&E (UECC)Telephone 01709 424455

For GP out of hours, contact your surgery

Useful websiteswww.therotherhamft.nhs.uk www.nhs.ukwww.gov.ukwww.patient.co.uk

Easyread websiteswww.easyhealth.org.ukwww.friendlyresources.org.ukwww.easy-read-online.co.uk

We value your commentsIf you have any comments or concerns about the services we have provided please let us know, or alternatively you can contact the Patient Experience Team.

Patient Experience TeamThe Oldfield CentreThe Rotherham NHSFoundation TrustRotherham HospitalMoorgate RoadRotherhamS60 2UD

Telephone: 01709 424461Monday to Friday 9.00am until 5.00pm Email: [email protected]

How to fi nd us

Hospital site plan

Rotherham main routes

One Way BAKER STREET

One way

TO WOODSIDE

Bus stop

Bus stop Bus stop

PAY ANDDISPLAY

PPAY ANDDISPLAY

P

PAY ANDDISPLAY

PP

Urgent & EmergencyCare Centre

SecurityCentre

MoorgateWing

Day SurgeryCentre

Rotherham Hospital

MOORGATE ROAD A618

OA

KW

OO

D H

ALL

DR

IVE

Busy BeesNursery

OakwoodHall

MainEntrance

MaternityEntrance

P

Two Way traffic

One Way traffic

Public Parking

Woodlands

Greenoaks

OldfieldCentre

OakwoodCommunityUnit

IT Centre

PAY ANDDISPLAY

LS 539 04/2020 V2 Jones & Brooks

Sustainable Forests / Low chlorine

Rotherham HospitalMoorgate Road

OakwoodRotherham

S60 2UD

Telephone 01709 820000www.therotherhamft.nhs.uk

gnrh analogues injections for the treatment of pelvic pain

Documents