Danazol (brand-name Danocrine) is an oral drug that was extensively used in the past to treat endometriosis. Although it was proven to be effective, its numerous side effects (see "Facing the side effects of danazol" later in this chapter) have resulted in its replacement by more modern medical treatments. However, for some women with endometriosis, it remains an optional medical treatment.
Danazol acts like two kinds of sex hormones, estrogen and testosterone. Its structure is very similar to testosterone, an androgen (male sex hormone). Although women normally have androgens, the quantities are smaller than in men. (All's fair with Mother Nature: Men have estrogen but in a lower level than women.) Danazol comes in capsules; the most common dose for endometriosis is 100 to 400 mg twice a day for three to nine months.
Contemplating danazol: How does it treat endometriosis?
Like all hormone therapies and surgery for endometriosis, danazol doesn't cure the disease. However, danazol can help with endometriosis in the following ways:
^ Shuts down your monthly cycle: Danazol raises androgen levels in your blood stream and lowers your estrogen levels by suppressing production in the ovaries. This change puts the body in a menopause-like state but doesn't affect the pituitary gland.
^ Shrinks endometrial implants: Like progesterone, danazol may have a direct effect on the endometrial tissue. That is, it may suppress the growth of the endometrium directly, not as a result of just lowering estrogen. Biopsies of the endometrium have shown this suppressive effect.
^ Decreases pain from implants by depriving them of estrogen stimulation: Without estrogen, endometriosis can't grow.
Some research shows that danazol may also inhibit the immune system and thereby decrease the inflammatory response to endometriosis. Up to 90 percent of women who use danazol report improvement in symptoms of endometriosis. Relief can come within a few months after starting treatment and typically lasts 6 to 12 months after stopping treatment. Symptoms return within a year for one-third of patients.
For years, danazol was the first-line hormonal therapy for endometriosis. But doctors rarely prescribe it now as an initial treatment and limit its use to six to nine months at a time because of its side effects when it is used. Danazol's side effects are common, affecting 80 percent of women who take the drug. Most of these side effects go away within several months after stopping treatment (but some may be permanent).
Side effects include
1 Acne: Occurs in around 13 percent of patients.
1 Decreased breast size: Uncommon but probably annoying!
i Depression and emotional changes: May include nervousness, anxiety, and emotional ability.
1 Fluid retention: Occurs in about 6 percent of patients.
i Flushing: Occurs in about 6 percent of patients.
i Increased cardiovascular risk: The rise in cholesterol is a real problem because the drug increases LDL (the bad one) by more than 35 percent and, worse, lowers HDL (the good stuff) by more than 50 percent. It also adversely affects apolipoprotein levels, another indicator of increased cardiovascular risk.
1 Increased risk of ovarian cancer: Be sure to discuss this effect with your doctor.
i Increase in male characteristics, such as deepening of the voice and increased facial hair and body hair (hirsutism): A change in voice can be permanent. Many women find these side effects unbearable and stop the medication prematurely. In our experience, more than 50 percent of women couldn't, or wouldn't, tolerate these side effects and stopped taking danazol before they had a clinical response.
1 Muscle cramps: May include muscles spasms or tremors, joint lock up, or swelling.
1 Oily skin and hair: Occurs in around 2 percent of patients.
1 Sugar level changes: This medicine may affect blood glucose (sugar) levels. If you notice a change in the results of your blood or urine glucose test, or if you have any questions about this effect, check with your doctor.
1 Skin rash: Danazol may cause your skin to be more sensitive to sunlight. Even short exposure to the sun can cause a skin rash, itching, redness, or severe sunburn. When you begin taking this medicine, take precautions: avoid intense sunlight; wear sunglasses, a hat, and long sleeves when you do go out; apply a good sun block; and avoid tanning salons and tanning beds.
1 Weight gain: Occurs in around 4 percent of patients.
Danazol shouldn't be taken in pregnancy because it can harm a developing fetus. You must use a barrier method of contraception (condoms or diaphragm) while taking danazol.
While you're taking danazol, your menstrual period may not be regular or you may not have a menstrual period at all. This change is normal. If regular menstruation doesn't begin within 60 to 90 days after you stop taking this medicine, check with your doctor. Danazol's effects on hormone regulation are usually reversible. But stopping danazol can cause FSH and LH secretion to rebound, resulting in increased fertility.
JK Danazol doesn't cause bone loss, as some other hormone treatments do, but I /^fet ) it does cause other complications that you should be aware of. You shouldn't J use danazol if you fall into any of the following categories:
I Chronic liver, kidney, or heart disease, which can become worse with danazol therapy
I Inherited disorder of skin pigment (porphyria)
I Pregnancy or possibility of pregnancy during treatment (danazol can harm a fetus)
I Abnormal vaginal bleeding without a known cause
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