{"id":22228,"date":"2025-02-08T08:00:00","date_gmt":"2025-02-08T14:00:00","guid":{"rendered":"https:\/\/naturalwomanhood.org\/?p=22228"},"modified":"2025-04-29T11:14:32","modified_gmt":"2025-04-29T16:14:32","slug":"orilissa","status":"publish","type":"post","link":"https:\/\/naturalwomanhood.org\/fr\/orilissa\/","title":{"rendered":"Orilissa, le \"traitement non hormonal de l'endom\u00e9triose\", est loin d'\u00eatre un m\u00e9dicament miracle"},"content":{"rendered":"\n

If I offered you the option of a hormone-free pill for endometriosis symptoms, would you jump at the chance to try it? What would your response be if I clarified that the medication \u201cworks\u201d  by putting your body into medically-induced menopause? And that it can cause the same bone density loss issues as the notorious Depo-Provera shot? Oh, and that it might make you suicidal? What then? <\/p>\n\n\n\n

 \u201cORILISSA is different\u2014it’s not a painkiller, injection, surgery, or birth control. And, it does not contain hormones.\u201d  So reads manufacturer Abbvie\u2019s website<\/a> for Orilissa (generic name elagolix), which was FDA approved in 2018 and has been prescribed to over 125,000 women. According to Abbvie, Orilissa is the first medication developed specifically for moderate to severe endometriosis pain, including painful periods, pelvic pain anytime, and pain with sex. (However, the Orilissa website acknowledges that only the higher dosage\u2014the one that causes more severe side effects\u2014is effective in reducing pain with sex.) <\/p>\n\n\n\n

How does Orilissa medically induce menopause? <\/span><\/h2>\n\n\n\n

The Orilissa website\u2019s description of how the medication works sounds innocuous enough. It states that \u201cTwo different doses of ORILISSA dial down estradiol to help control endometriosis pain.\u201d Under Mechanism of Action in Orilissa\u2019s full prescribing information document, we further read: <\/p>\n\n\n\n

\n

“ORILISSA is a GnRH receptor antagonist that inhibits endogenous GnRH signaling by binding competitively to GnRH receptors in the pituitary gland. Administration of ORILISSA results in dose-dependent suppression of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), leading to decreased blood concentrations of the ovarian sex hormones, estradiol and progesterone.\u201d<\/p>\n<\/blockquote>\n\n\n\n

It\u2019s that last point\u2014the one about decreased blood concentrations of estradiol and progesterone\u2014where the trouble comes from. <\/p>\n\n\n\n

In fact, the dramatic drop in estrogen caused by Orilissa is so steep that it causes a medically-induced menopause, although it is presumably reversible once the medication is stopped. (According to the manufacturer\u2019s website, in women who took Orilissa for 6 months, \u201cthe majority of women, ~60%, in clinical trials who took either dose of ORILISSA got their period within a month after they stopped taking ORILISSA. And about 95% got their period within 6 months.\u201d) The dramatic drop in estrogen experienced by women on Orilissa is not only responsible for the loss of their pain (and periods), but it\u2019s also the culprit behind the drug\u2019s potentially severe side effects (more on this in a minute). <\/p>\n\n\n\n

Orilissa may relieve endometriosis pain\u2026 <\/span><\/h2>\n\n\n\n

A 2023 literature review<\/a> reported that after one year of treatment, Elagolix (i.e., Orilissa) users reported 50-52% reduction in painful periods in the lower dose group, and 76-78% in the higher dose group [1]. General pelvic pain was reduced by 66-68% in the lower dose group, and by 67-69% in the higher dose group. Pain with sex was the clinical endpoint least improved by Orilissa. Still, low dose users reported a 45% improvement, while higher dose users reported a 58-60% improvement [1].  <\/p>\n\n\n\n

\u2026.But that\u2019s not all it can do<\/span><\/h2>\n\n\n\n

Manufacturer Abbvie\u2019s list of Orilissa\u2019s most common side effects reads like a who\u2019s who of menopause symptoms, including \u201chot flashes and night sweats, headache, nausea, difficulty sleeping, absence of periods, anxiety, joint pain, depression, and mood changes.\u201d But wait, there\u2019s more. The physician prescribing information<\/a> leads off with specific warnings for bone-density loss (comparable to the disastrous Depo-Provera<\/a> shot) even in healthy young women, \u201csuicidal ideation and mood disorders,\u201d liver injury, and increased blood clot risk if taken with hormonal contraceptives (which shouldn\u2019t be taken during or 28 days after stopping Orilissa). <\/p>\n\n\n\n

Importantly, a 2021 literature review<\/a> on GnRH antagonists for endometriosis noted that the longest research trials conducted to date lasted for just one year, so no \u201clong-term\u201d safety data is available yet. However, fully 90% of participants taking Orilissa for a year reported hot flashes. The same review observed that after just one year of Orilissa use, women experienced decreased bone mineral density (BMD) in the lumbar spine by 20-23% from the beginning of treatment, depending on the dosage. For context, women in early menopause (the most significant period of natural bone mineral density loss in a woman\u2019s life) experience up to 2.5% BMD loss in a year [2].\u00a0Of note, the hot flash and BMD loss side effects of Orilissa are comparable to those of another oral GnRH antagonist, relugolix, but worse than those associated with injectable GnRH antagonists cetrorelix and ganirelix.<\/p>\n\n\n\n

Also after just 12 months, women\u2019s LDL cholesterol, HDL cholesterol, total cholesterol (i.e., LDL + HDL) and triglycerides\u2014all markers of metabolic health\u2014were higher than when the women started Orilissa. HDL is called \u2018good cholesterol\u2019 because it helps remove the other forms of cholesterol from the body. Elevated levels of LDL cholesterol and triglycerides, on the other hand, significantly increase your risk of heart attack and stroke. <\/p>\n\n\n\n

What treatment options do women have for endometriosis that don\u2019t risk their bone health, mental health, cardiovascular health, liver health, and more? <\/span><\/h2>\n\n\n\n

As we\u2019ve emphasized over and over again at Natural Womanhood, women need their periods<\/a>. Most accurately, they need the health benefits that come from regular ovulation (and ovulation precedes every true period). In fact, regular ovulation specifically benefits bone<\/a> and brain health<\/a>, the exact opposite of what Orilissa does. Shutting down a woman\u2019s hormones altogether, which is the desired <\/em>effect of Orilissa, deprives women of these benefits. <\/p>\n\n\n\n

Our Endometriosis topic page<\/a> covers everything from the urgent need for earlier diagnosis (preferably as soon as the teen years), to symptoms, to treatment options (including a medication<\/a> that is \u201csafe, cheap, and old\u201d), and more. After reading through these articles, a great next step for getting actual, safe treatment for endometriosis is to seek out a clinician trained in restorative reproductive medicine (RRM)<\/a>, which seeks to optimize a woman\u2019s hormones so that she can reap all the rewards of healthier cycles\u2013including<\/em> diminished pain. <\/p>\n\n\n\n

The bottom line<\/span><\/h2>\n\n\n\n

For some women, endometriosis pain may be so intense and life-altering that they\u2019ll try anything, but Orilissa is a far cry from the endometriosis treatment women deserve. As one cautious article about Orilissa summed up<\/a>, \u201cIf we’re getting excited about pills that force us into early menopause, thin our bones and possibly make us suicidal, we still have a long way to go.\u201d <\/p>\n\n\n\n

References:<\/span><\/h4>\n\n\n\n

[1] Rzewuska AM, \u017bybowska M, Sajkiewicz I, Spiechowicz I, \u017bak K, Abramiuk M, Ku\u0142ak K, Tarkowski R. Gonadotropin-Releasing Hormone Antagonists-A New Hope in Endometriosis Treatment? J Clin Med. 2023 Jan 28;12(3):1008. doi: 10.3390\/jcm12031008. PMID: 36769656; PMCID: PMC9918258.<\/p>\n\n\n\n

[2] Shieh A, Karlamangla AS, Huang MH, Han W, Greendale GA. Faster Lumbar Spine Bone Loss in Midlife Predicts Subsequent Fracture Independent of Starting Bone Mineral Density. J Clin Endocrinol Metab. 2021 Jun 16;106(7):e2491-e2501. doi: 10.1210\/clinem\/dgab279. PMID: 33903908; PMCID: PMC8208668.<\/p>\n","protected":false},"excerpt":{"rendered":"La perte de densit\u00e9 osseuse est plus grave que la m\u00e9nopause","protected":false},"author":85,"featured_media":22222,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":true,"_kad_blocks_custom_css":"","_kad_blocks_head_custom_js":"","_kad_blocks_body_custom_js":"","_kad_blocks_footer_custom_js":"","csco_singular_sidebar":"","csco_page_header_type":"","csco_page_load_nextpost":"","csco_post_video_location":[],"csco_post_video_url":"","csco_post_video_bg_start_time":0,"csco_post_video_bg_end_time":0,"footnotes":""},"categories":[5364,5181],"tags":[4719,6441,6442],"class_list":["post-22228","post","type-post","status-publish","format-standard","has-post-thumbnail","category-endometriosis","category-reproductive-and-menstrual-disorders","tag-endometriosis","tag-endometriosis-medication","tag-orilissa","cs-entry","cs-video-wrap"],"acf":[],"yoast_head":"\nOrilissa for endometriosis-Natural Womanhood<\/title>\n<meta name=\"description\" content=\"Should you try Orilissa, the hormone-free medication for endometriosis? 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