According to Dr. John Rock, Professor and Director Division of Reproductive Gynecology at John Hopkins University, with a good exercise regimen, you can avoid most of the side effects of danazol. Danazol can provide pain relief and may improve the immune profile.

Dr. John Collins, Professor of Gynecology and Epidemiology, and his colleagues at McMaster University in Hamilton Ontario reviewed only well designed studies and found that neither progesterone nor danazol was better than placebo for the treatment of endometriosis associated infertility.

The Gnrh Drugs

There are four GNRH drugs now available on the market. They were originally only approved for the treatment of prostate cancer in men.

SYNAREL: This is a nasal spray.

LUPRON: This is a monthly or daily injectable at the dose of 3.75mg a month. Too many North American women have been receiving the incorrect and higher dose of 7.5mg a month that is the recommended dose for men with prostrate cancer. This higher dose can cause severe side effects.

ZOLADEX: This drug is a monthly injectable and will be approved for use in endo sometime in 1993 in both Canada and the U.S.

BUSERELIN: This is a nasal spray or daily injectable that is being used in Europe and will soon be approved for use in Canada.

GNRH stands for gonadotropin releasing hormone. This is a hormone released by the hypothalamus in the brain, which triggers other hormones from the pituitary gland in the brain, which in turn triggers the female hormones estrogen and progesterone to be released from the ovaries. These drugs work by exhausting certain areas in the pituitary gland. Lupron is 15 times stronger that the naturally occurring GNRH in the body, and synarel is 200 times more potent.

The net effect of the GNRH drugs is, like danazol, a pseudo-menopause, but much more severe. The major side effect seems to be hot flashes. Other side effects include vaginal dryness, headaches, mood swings, depression, acne, muscle pain and reduction in breast size as well as a decreased sex drive. Another major concern about these drugs is that they cause decreased bone density that can lead to osteoporosis. This effect appears to be more pronounced with synarel than with lupron. The usual maximum course of treatment is six months. A woman should have a bone scan done before she attempts a second course of any of these drugs.

All these drugs are very new, very powerful and very expensive (about $400.00 to $600.00 a month). Too low doses of GNRH may also pose health problems. Researchers found that low doses can trigger hyper-stimulation of the ovaries resulting in high estrogen levels which, in turn, worsen endo. The long-term effects of tampering with the hormonal control areas in a woman's brain will not be known for ten to 20 years. The effect on fertility is dubious. Studies have shown no difference between the synarel and danazol in terms of pain relief (about 80 percent) and fertility enhancement (none).

The latest approach is to "add back" estrogen and progesterone hormones to prevent side effects of bone loss and menopausal symptoms. This adds the complication of the side effects of these two drugs. This concept of total hormonal manipulation is, in my opinion, still experimental and the long-term effects are completely unknown.

An Approach To Using Hormonal Treatments

In my opinion, use the least harmful agent first and the one that has been around for the longest time. If possible, use drugs only for crisis management. For example, when the pain becomes unbearable and you want to buy time to think about your options.

It makes sense to start with provera tablets. Dr. Olive suggests 100mg daily by mouth for six months. The rationale is simple. Provera has been proven to be just as good as danazol and the GNRH drugs for the relief of pain and it is very inexpensive.