GnRH Medications: Pressing Pause on Your Hormones
Being told you might need a medication that “shuts down your hormones” can sound… intense.
Cold. Permanent. Like something you didn’t sign up for.
But GnRH medications aren’t about taking something away from you. They’re about temporarily pressing pause — often to give your body relief, clarity, or a reset.
Used thoughtfully, these meds can be incredibly effective. Used without explanation, they can feel terrifying. Let’s talk about what they actually do — and when they make sense.
What Are GnRH Medications?
GnRH stands for gonadotropin-releasing hormone. It’s a hormone made by your brain that tells your ovaries to make estrogen (and progesterone).
GnRH medications work by interrupting that signal.
The result?
Your ovaries temporarily stop producing estrogen — creating a reversible, medication-induced menopause.
Important word there: reversible.
Agonists vs Antagonists: What’s the Difference?
There are two main types of GnRH medications.
GnRH Agonists
Examples include medications like Lupron (leuprolide).
These work in two phases:
• A brief hormone surge, called a flare
• Followed by suppression of estrogen production
The flare phase usually lasts 1–2 weeks, but for some people it can last longer. During this time, symptoms may temporarily feel worse before they improve.
This is important to know ahead of time. If no one explains it, people often think the medication isn’t working or that something has gone wrong. Knowing a flare is expected — and temporary — helps you prepare for it and not lose hope.
GnRH agonists are given as injections, most commonly:
• every 1-3 months
Once the shot is given, you have to ride it out until it wears off. The longer you’re on it, the longer it can take for your period to return after stopping.
GnRH Antagonists
Examples include newer oral medications such as elagolix (Orilissa) and relugolix-based combinations (Myfembree).
These medications:
• Block estrogen production right away
• Do not cause a flare
• Are taken as daily pills (sometimes once daily, sometimes twice daily depending on the medication)
A major advantage is flexibility:
You can stop them at any time, and hormone production begins to recover.
For many patients, this means:
• Faster symptom relief
• More predictable side effects
• Greater sense of control
Both agonists and antagonists ultimately do the same thing — they just get there differently.
Why Would Someone Be Prescribed a GnRH Medication?
GnRH medications are commonly used for conditions that are estrogen-driven, including:
• Fibroids
• Severe pelvic pain
• Heavy or prolonged bleeding
• Severe PMDD
• Sometimes as a diagnostic tool to see if symptoms improve when estrogen is suppressed
They’re also sometimes used before surgery to calm inflammation or shrink tissue.
Using GnRH Medications Before Surgery
Sometimes GnRH medications are used before surgery to make the next step easier and safer.
Over longer-term use, these medicines can shrink the size of certain types of pathology. For example, fibroids can shrink by up to ~50% after six or more months of treatment, because fibroids feed off estrogen and progesterone and may shrink when those hormones are suppressed.
In some cases, this pre-treatment can:
• Allow for a minimally invasive surgery instead of an open one
• Reduce blood loss
• Lower overall surgical risk
GnRH medications can also help stabilize endometriosis leading up to surgery. They may help shrink cysts associated with endometriosis (endometriomas) or reduce inflammation. They won’t undo damage that’s already been done by the disease, but they can help stop it from getting worse — which can be useful before surgical excision.
Is This the Same as Menopause?
Functionally? Yes.
Philosophically? Not exactly.
GnRH medications create a temporary, controlled version of menopause — one that:
• Is medically supervised
• Can be adjusted
• Can be stopped
Once the medication is discontinued, hormone production typically resumes.
Natural menopause is more of a gradual kind of tapering off of estrogen that is ultimately permanent and not reversible. GnRH medications create a more abrupt, however temporary, version of menopause.
What Do GnRH Medications Feel Like?
Because estrogen drops, side effects can include:
• Hot flashes
• Night sweats
• Mood changes
• Vaginal dryness
• Low libido
• Sleep disruption
Not everyone experiences all of these, and severity varies widely.
Which is why add-back therapy matters so much.
What Is Add-Back Therapy (and Why It Matters)?
Add-back therapy means giving small, carefully chosen doses of hormones alongside GnRH medications - most commonly daily norethindrone.
It may seem counterintuitive to block hormones and then add them back. However, add-back therapy does not cancel the benefits of GnRH therapy. It makes it tolerable and safer for longer use.
The goal is to:
• Protect bone health
• Reduce menopausal side effects
• Maintain quality of life
Think of it as equivalent to someone who’s gone through natural menopause and then using hormone replacement therapy. They’re usually taking just enough to calm their symptoms without causing any harmful side effects.
Add-back is so important that some of the medicines actually now combine this into the treatment. Myfembree is a combination of a GnRH antagonist, as well as low-dose estrogen and progesterone, so that you get the effects of add-back — you get the best of both worlds all in one pill.
If add-back isn’t discussed, it’s worth asking about.
How Long Can Someone Stay on GnRH Medications?
GnRH medications are not designed to be used lifelong.
They’re often a bridge, not a forever solution — a way to calm symptoms, gather information, or buy time while planning next steps.
In general:
• GnRH medications alone are approved for use up to 6 months
• With add-back therapy, you can extend this safely up to 2 years
Rarely, the medicines could be used longer than this in special circumstances, but often require closer monitoring, such as bone density scans, and your doctor may have to fight your insurance to approve them.
The main concern with prolonged estrogen suppression is bone density loss. However, used over a short period, usually these changes take years to become problematic. Using these medicines for the short term doesn’t often cause any sustainable issues. Additionally, any bone density changes typically reverse once you’re off the medicine and estrogen is back to normal. When on add-back, bone density is typically preserved.
Used appropriately and monitored, these medications can be very safe.
Will GnRH Medications Affect My Fertility?
This is a common — and very valid — concern.
GnRH medications do not hurt the ovaries, do not make you lose eggs, and do not reduce ovarian reserve. They do not change your baseline fertility.
You most likely won’t get pregnant while you’re on them, but fertility should return to whatever your baseline was prior to using the medicines.
How Do You Stop GnRH Therapy?
Stopping depends on the medication, but generally:
• Hormone production resumes over weeks to months
• Periods often return
• Symptoms may or may not return
Sometimes it controls symptoms so well that this is the perfect chance to then bridge to another more long-term treatment — for instance, switching to a hormonal medication or an IUD for ongoing treatment of pain or bleeding while coming off of these medicines.
Bottom Line
GnRH medications aren’t about taking control away from your body.
They’re about a strategic pause.
For the right person, at the right time, with the right support, they can be powerful tools — not punishments, not last resorts, and not something to fear.
Understanding what they do makes all the difference.
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