Elagolix

How it works

It competitively blocks pituitary GnRH receptors, suppressing luteinising hormone and follicle-stimulating hormone release and thereby lowering ovarian oestrogen production to reduce endometriotic activity and pain.

Prescribing in practice

• Its hypo-oestrogenic effect causes dose-dependent loss of bone mineral density, so duration of use is limited and bone health must be considered, particularly with the higher-exposure regimen.
• Exclude pregnancy before starting and advise effective non-hormonal contraception, as it is not a contraceptive and can reduce the efficacy of oestrogen-containing contraceptives.
• Hot flushes and other menopausal-type symptoms are common owing to oestrogen suppression.

Monitoring

Assess and monitor bone mineral density with longer use, and review menopausal-type symptoms, mood and liver-related parameters as clinically indicated.

Counselling the patient

• Use a reliable non-hormonal contraceptive method, as this medicine is not a contraceptive.
• Hot flushes, night sweats and mood changes may occur because of lowered oestrogen.
• Treatment duration is limited to protect your bones, so attend reviews as arranged.

Evidence & guidelines

Elagolix has been evaluated in randomised trials demonstrating reduced dysmenorrhoea and non-menstrual pelvic pain in endometriosis, with dose-dependent reductions in bone mineral density.