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Treatment of endometriosis: danazol and its side effects TREATMENT OF ENDOMETRIOSIS: DANAZOL AND ITS SIDE EFFECTS
Danazol can cause a wide variety of side effects and there is a huge variation in the way that women respond to the drug. Most women experience some side effects and a few experience many. For some women the side effects are quite mild and of no real significance, while for others the side effects are severe and debilitating and they are unable to complete a course of treatment. A few women say that they have never felt better. Unfortunately, there is no way of predicting how you will respond.
The number and severity of side effects experienced may be related to the dosage being taken, so reducing your dose to the lowest needed to stop your periods may reduce the side effects experienced.
Some of Danazol's side effects are due to the fact that it is a weak synthetic male hormone. It may cause both androgenic side effects (male characteristics) and anabolic side effects (bodybuilding effects).
The most common androgenic and anabolic side effects are weight gain, fluid retention, acne, oily skin and/or hair, bloating, decreased breast size, increase in facial and/or body hair, increased muscle bulk, deepening of the voice, change in appetite and enlargement of the clitoris.
Weight gain is by far the most common side effect of Danazol. The vast majority of women experience a significant gain in weight — usually one to five kilograms but occasionally more. Some women put on all or most of the increased weight quickly, while others gain weight gradually. Once treatment has finished most women lose the weight gain within a month or two but it often takes some time to lose the last kilogram.
Some women experience an increased growth of facial hair while on Danazol. This does not mean that you will grow a 'beard'. The facial hair is not normally noticeable to other people as there is usually only slightly more than normal and it is very fine and downy. Some women also experience an increase in the amount of body hair, particularly on their legs and around their nipples.
If you experience profuse hair growth you should notify your gynaecologist as this side effect is sometimes not reversible.
Some women experience a change in their voice. The change may involve a loss of the higher notes, or the voice may become husky, or you may find that it peters out at times. Often the changes are only evident when you have been using your voice for some time or when you are trying to project your voice. The changes are often quite subtle so it is probably worthwhile organising with someone who is close to you to monitor your voice for any possible changes. If you notice any changes notify your gynaecologist immediately as they may be irreversible.
If you are a professional or amateur singer you should think carefully about taking Danazol because the voice changes are sometimes irreversible even if you cease treatment as soon as you notice any change.
Enlargement of the clitoris is rare but, as it may be irreversible, if you notice an enlargement you should contact your gynaecologist immediately.
Some of the side effects of Danazol are due to the low levels of oestrogen in the body. These side effects are those usually associated with the menopause and they include hot flushes, night sweats and vaginal dryness.
Danazol may also affect blood sugar levels and the way that the body uses sugars. In particular, it can cause a decreased glucose tolerance. Women with diabetes should be monitored carefully while taking Danazol.
Danazol also alters the levels of fats and cholesterol in the blood during treatment in the same way as people who are at risk of developing heart disease. Although there is no proof that longer treatment is harmful, most doctors are not prepared to continue Danazol treatment for more than six to nine months at a time because of the possibility that it may increase your risk of developing heart disease later in life.
Danazol can also cause a wide range of miscellaneous side effects including vaginal bleeding, muscle cramps, nausea, vomiting, headache, dizziness, depression, skin rash, fatigue, irritability, mood swings, decreased libido, insomnia, jaundice and liver disease.
Vaginal bleeding is common, particularly in the first two months of treatment. The bleeding may be intermittent spotting or staining, or it may be like a scant period. Generally, this does not mean that the treatment is not working. It usually resolves itself in time and most women will stop bleeding by the end of the second month of treatment.
Muscle cramps, which are common, may be severe and distressing.
You can stop taking Danazol at any stage if you are unable to cope with the side effects. First contact your gynaecologist and discuss your problems as there may be ways to manage the symptoms.
When you stop taking Danazol you will usually start ovulating and menstruating within four to six weeks. Most of the side effects of Danazol will disappear soon after you have completed your course of treatment.
Most women who become pregnant do so within six to twelve months of completing their treatment of Danazol. In the past there has been some controversy regarding how soon after completing treatment you should try to conceive. Some gynaecologists believed that it was probably best to avoid becoming pregnant until you had one normal period in order to allow the Danazol to be completely cleared from your body before you became pregnant. Most gynaecologists now believe that there is no advantage in delaying conception and that you can start trying to conceive as soon as you have finished your course of Danazol.
There is no information available about the long-term side effects of taking a single course of Danazol therapy and even less is known about the long-term effects of taking repeated or prolonged courses.
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