Can't Get Your Estradiol/Norethindrone/Relugolix Prescription Filled? You Have Options

If you've been prescribed Estradiol/Norethindrone/Relugolix (brand name Myfembree) but can't fill it — whether because of availability issues, insurance denials, or cost — it's important to know that other treatment options exist for uterine fibroids and endometriosis.

This article covers what Estradiol/Norethindrone/Relugolix is, how it works, and several alternative medications your doctor may consider. Always talk to your prescriber before switching medications — this guide is for informational purposes only.

What Is Estradiol/Norethindrone/Relugolix (Myfembree)?

Myfembree is a once-daily oral tablet that combines three active ingredients in a single pill:

• Relugolix (40 mg) — a GnRH receptor antagonist that suppresses estrogen and progesterone production
• Estradiol (1 mg) — a low-dose estrogen for hormonal add-back therapy
• Norethindrone Acetate (0.5 mg) — a progestin to protect the uterine lining

It's FDA-approved for:

• Heavy menstrual bleeding associated with uterine fibroids in premenopausal women
• Moderate to severe pain associated with endometriosis in premenopausal women

For a detailed overview, see our guide on what Estradiol/Norethindrone/Relugolix is and how to take it.

How Does Estradiol/Norethindrone/Relugolix Work?

The key ingredient, Relugolix, works by blocking GnRH receptors in the pituitary gland. This reduces the production of LH (luteinizing hormone) and FSH (follicle-stimulating hormone), which in turn lowers estrogen levels. Since uterine fibroids and endometriosis tissue are estrogen-dependent, reducing estrogen helps shrink fibroids and decrease endometriosis-related pain and bleeding.

The Estradiol and Norethindrone Acetate provide "add-back" therapy — just enough hormones to prevent severe bone loss and reduce uncomfortable symptoms like hot flashes, without undoing the therapeutic benefit. Learn more in our article on how Estradiol/Norethindrone/Relugolix works.

Alternative Medications for Uterine Fibroids and Endometriosis

If you can't access Myfembree, the following medications treat similar conditions. Each has its own benefits, limitations, and side effect profile.

1. Oriahnn (Elagolix/Estradiol/Norethindrone Acetate)

What it is: Oriahnn is the closest alternative to Myfembree. It's also a GnRH antagonist with built-in hormonal add-back therapy, FDA-approved for heavy menstrual bleeding from uterine fibroids.

How it's different:

• Requires twice-daily dosing — a morning capsule (Elagolix 300 mg + Estradiol 1 mg + Norethindrone Acetate 0.5 mg) and an evening capsule (Elagolix 300 mg alone)
• Only approved for uterine fibroids — not approved for endometriosis (unlike Myfembree, which covers both)
• Treatment limited to 24 months
• Made by AbbVie

Cost: Similar price range to Myfembree, around $1,000–$1,500/month without insurance. AbbVie offers a savings program for eligible patients.

2. Orilissa (Elagolix)

What it is: Orilissa is a GnRH antagonist approved for moderate to severe endometriosis pain. Unlike Myfembree and Oriahnn, it does not include built-in add-back therapy.

How it's different:

• Available in two doses: 150 mg once daily (for up to 24 months) or 200 mg twice daily (for up to 6 months)
• Approved for endometriosis only — not for uterine fibroid bleeding
• Without add-back therapy, it may cause more significant bone loss and hot flashes — though doctors can prescribe separate add-back if needed
• Made by AbbVie

Cost: Approximately $900–$1,200/month without insurance.

3. Lupron Depot (Leuprolide Acetate)

What it is: Lupron Depot is a GnRH agonist (not antagonist) given as an intramuscular injection — either monthly or every three months. It's used for both endometriosis and as preoperative treatment for uterine fibroids.

How it's different:

• Administered as an injection (not an oral pill) — requires a healthcare provider visit
• Works differently: causes an initial hormonal "flare" (temporary worsening of symptoms) before suppression takes effect
• Generally used for shorter treatment courses (3–6 months) due to more significant bone loss risk
• Separate add-back therapy is often prescribed alongside it
• Made by AbbVie

Cost: Approximately $1,000–$1,800 per injection without insurance, depending on the dose and frequency.

4. Hormonal IUD (Mirena or Liletta)

What it is: Levonorgestrel-releasing intrauterine devices (IUDs) like Mirena or Liletta are commonly used as first-line treatment for heavy menstrual bleeding, including bleeding caused by fibroids.

How it's different:

• Works locally in the uterus — does not suppress estrogen levels systemically
• Does not shrink fibroids, but can significantly reduce menstrual bleeding
• Lasts 5–8 years, making it one of the most cost-effective options long-term
• Not specifically approved for endometriosis pain, though sometimes used off-label
• May not be effective if fibroids distort the uterine cavity

Cost: $0–$1,300 for insertion (often fully covered by insurance). No ongoing monthly medication cost.

How to Decide Which Alternative Is Right for You

The best alternative depends on your specific condition, medical history, and preferences. Consider these questions when talking to your doctor:

• What condition are you treating? If you have endometriosis, Orilissa or Lupron may be better alternatives. If you have fibroids, Oriahnn or a hormonal IUD might work.
• Do you prefer oral or injectable medication? If you want to avoid injections, Oriahnn or Orilissa are oral options.
• How long do you need treatment? For long-term management, a hormonal IUD may be the most sustainable option.
• What's your budget? A hormonal IUD is typically the most affordable long-term option, while oral GnRH medications are all in a similar high-cost range.

For help finding a provider, see our guide on how to find a doctor who prescribes Estradiol/Norethindrone/Relugolix.

Final Thoughts

Not being able to fill your Estradiol/Norethindrone/Relugolix (Myfembree) prescription is frustrating, but you do have options. Oriahnn, Orilissa, Lupron Depot, and hormonal IUDs can all be effective alternatives depending on your situation.

Before switching, we recommend trying to find Myfembree through specialty pharmacies or Medfinder first. If that's not possible, schedule a conversation with your prescriber to discuss which alternative makes the most sense for your health needs and budget.