Should You Try Hormone Therapy Before Endometriosis Surgery?

If you’re facing surgery for endometriosis, especially deep infiltrating multiorgan symptom endometriosis, you’re probably exhausted by pain, gut and bladder issues, and constant worry about what recovery will look like. You want your surgery to change things for the better—and you deserve the best chance at long-term relief. One way some doctors try to tip the scales is by prescribing a hormone treatment called a GnRH agonist before surgery. But is this right for you—what are the real benefits, and what are the downsides?

Recent research looked at thousands of women like you who had surgery for deep endometriosis affecting the bowel and bladder. This study zeroed in on whether starting GnRH agonists (sometimes called a “medical menopause” shot or implant) before surgery actually helps with pain and other stubborn symptoms—both immediately and in the months that follow. There are other hormone alternatives like progestogens and antagonists which were not part of this study. There is reason to believe that some work better than others but overall the comparison data for preoperative use is scarce.

Let’s break down what this could mean for your quality of life, what you need to consider, and how to have a better-informed conversation with your doctor.

What Are GnRH Analogues—And What Do They Do Before Surgery?

GnRH analogues (gonadotropin-releasing hormone agonists and antagonists) are medications that essentially hit pause on your ovaries, lowering estrogen to very low levels—like what you’d see after menopause. This can quickly reduce endometriosis activity and shrink inflamed tissue before surgery, which doctors hope might make the operation safer and improve your chances of lasting symptom relief.

You might get these medications as a monthly injection (like leuprorelin/Lupron®, triptorelin, or goserelin/Zoladex®), a nasal spray, or occasionally as an implant. Doctors typically prescribe them for a few months before your surgery.

How Well Does Pre-Op GnRH Therapy Really Work?

Here’s what you can realistically expect if you take a GnRH agonist for a few months before your surgery:

• Pain Relief: Up to one year after surgery, women who used GnRH agonists beforehand had less pain—both menstrual and non-menstrual—compared to those who went straight to surgery. That includes pain with your period, pain between periods, and deep pelvic/back pain.
• Bowel Symptoms: Bowel issues like constipation, difficulty emptying, and pain with bowel movements—all common with rectovaginal/colorectal endometriosis—tend to improve for at least 12 months after surgery if you used these medications first.
• Bladder Relief: If bladder pain is part of your story, you may notice significant improvement at 12 months post-surgery with pre-surgical GnRH use.
• Quality of Life: Most importantly, a larger number of women reported feeling better overall for up to two years after surgery when they added this hormone therapy to their surgical plan.

Think of it like clearing the playing field before a big game—it doesn’t guarantee total relief forever, but it can make a real difference in how you recover.

Side Effects: What Should You Watch Out For?

The benefits sound promising—but these medications come with a serious caveat. Because GnRH agonists suppress estrogen, you’ll likely face menopausal-type side effects even if you’re nowhere near menopause. The most common are:

• Hot flashes and night sweats
• Vaginal dryness or irritation
• Mood fluctuations—anxiety, depression, or irritability
• Low energy and trouble sleeping
• Loss of bone density if used long-term without “add-back” therapy

Doctors sometimes prescribe a small amount of estrogen/progestin (“add-back” therapy) alongside GnRH agonists to manage these symptoms and protect your bones. Still, many women find the side effects tough, especially if they’ve experienced mood disorders before.

Is Pre-Op GnRH Therapy Right for Everyone?

This approach is most often considered for women with deep endometriosis involving the bowel or bladder—especially if you’re dealing with severe pain, challenging bowel symptoms, or if your surgeon thinks it could make the surgery safer or easier.

It’s not for everyone. If side effects sound unmanageable, or if you have certain health conditions (like a history of severe depression or already low bone density), your doctor may suggest skipping hormone therapy and going straight to surgery.

Also, these improvements generally last up to 1-2 years after surgery. GnRH agonists are not a permanent fix and aren’t meant to replace surgery for deep disease. If you have milder endo, another location, or are trying to conceive soon, the benefits may be less clear.

How Long Before You See a difference?

Most women notice a difference within the first few weeks to months on GnRH agonists—then continue to see those benefits carry through their surgery and into the recovery months that follow. The biggest improvements in pain and GI symptoms are often still noticeable one year after surgery if you pre-treated with hormone therapy.

Practical Takeaways: What to Discuss With Your Doctor

Before starting any treatment, especially one with real side effects, here’s what you deserve to know:

• How severe are your symptoms—and does your surgery involve rectovaginal or bowel endometriosis?
• Are you a candidate for short-term GnRH agonist therapy, or would another option make more sense?
• What side effects can you expect—and how will “add-back” therapy factor in?
• What will the timeline be for starting medication and scheduling surgery?
• Are there medical reasons GnRH therapy might be risky for you (such as cardiovascular disease, significant depression, liver disease, osteoporosis, or pregnancy plans)?
• How will success be measured—should you keep a daily pain and symptom journal before and after treatment?

If you start to feel increasingly depressed, anxious, or notice other worrying symptoms on hormone therapy, contact your healthcare provider quickly. Strong side effects are not a failure on your part—you deserve support and may need a different approach.

Reality Check: What We Still Don’t Know

It’s important to keep expectations realistic. Pre-surgical GnRH analogues can temporarily reduce pain, especially in tough bowel and bladder endometriosis cases, but it’s not a cure—and symptoms can eventually return, especially if endo is aggressive or incomplete removal happens during surgery. Long-term effects beyond two years are still unclear but can be very persistent and disturbing.

This strategy also isn’t proven to help every type of endometriosis or to avoid surgery entirely. If you’re not a candidate, don’t lose hope—there are other medication and non-hormonal pain management options, plus support for every step of surgery and recovery.

Remember: Each journey is unique. Your priorities—pain relief, bowel comfort, fertility, emotional wellbeing—matter. Use this information as a springboard for deeper conversations with your care team and to advocate for a plan that fits your needs.