When You Can't Get Orilissa, What Are Your Options?

Orilissa (Elagolix) was a breakthrough when it was approved in 2018 — the first oral GnRH antagonist for endometriosis pain. But in 2026, many patients still struggle to access it. Whether the issue is availability at your pharmacy, insurance denials, or a price tag that can reach $1,700 per month, you may be wondering: what else is out there?

The good news is that several effective alternatives exist. In this article, we'll explain how Orilissa works and walk through the most common alternatives your doctor may consider.

What Is Orilissa and How Does It Work?

Orilissa is a GnRH (gonadotropin-releasing hormone) antagonist made by AbbVie. Its active ingredient, Elagolix, blocks the GnRH receptor in the pituitary gland. This suppresses the production of estrogen and progesterone — the hormones that fuel endometrial tissue growth outside the uterus.

By lowering estrogen levels, Orilissa reduces the inflammation and pain caused by endometriosis. It's available in two doses:

• 150 mg once daily (for up to 24 months) — provides partial estrogen suppression
• 200 mg twice daily (for up to 6 months) — provides more substantial estrogen suppression

Understanding this mechanism is important because it helps explain why certain alternatives may work for you — and why others work differently.

Alternative 1: Lupron Depot (Leuprolide Acetate)

Lupron Depot is a GnRH agonist — which is different from Orilissa's GnRH antagonist mechanism, but achieves a similar end result. After an initial hormone surge (called a "flare"), Lupron Depot suppresses estrogen production, effectively putting the body into a temporary menopausal state.

Key facts about Lupron Depot:

• How it's given: Injection, typically once monthly or once every 3 months
• Cost: Around $1,000–$1,500 per injection, but often better covered by insurance
• Duration: Usually limited to 6–12 months due to bone loss concerns
• Pros: Well-established, decades of clinical use, no daily pills to remember
• Cons: Requires injections, initial hormone flare can temporarily worsen symptoms, similar bone loss risks as Orilissa

Lupron Depot is often used with "add-back" therapy (low-dose Norethindrone) to reduce side effects like hot flashes and bone loss.

Alternative 2: Myfembree (Relugolix, Estradiol, and Norethindrone Acetate)

Myfembree is a newer oral option that combines a GnRH antagonist (Relugolix) with add-back hormones (estradiol and norethindrone acetate) in a single pill. It was originally approved for uterine fibroids and has been studied for endometriosis.

Key facts about Myfembree:

• How it's taken: One tablet daily by mouth
• Cost: Approximately $1,000–$2,000 per month without insurance
• Pros: Oral, once-daily dosing. The built-in add-back therapy helps protect bone density and reduces hot flashes.
• Cons: Expensive, may also require prior authorization, relatively newer medication

If you like the idea of an oral GnRH antagonist (like Orilissa) but want built-in protection against bone loss, Myfembree may be worth discussing with your doctor.

Alternative 3: Norethindrone Acetate

Norethindrone acetate is a progestin (synthetic progesterone) that is used off-label for endometriosis pain. It works by suppressing ovulation and thinning the endometrial lining, which can reduce pain.

Key facts about Norethindrone acetate:

• How it's taken: Oral tablet, typically 5 mg daily
• Cost: Very affordable — often under $30 per month with or without insurance
• Pros: Extremely inexpensive, widely available, well-tolerated by many patients
• Cons: Different mechanism than Orilissa (doesn't directly suppress GnRH), may cause breakthrough bleeding, weight gain, or mood changes. Not FDA-approved specifically for endometriosis.

For patients who can't access or afford Orilissa, Norethindrone is often the first alternative doctors consider because of its low cost and availability.

Alternative 4: Depo-Provera (Medroxyprogesterone Acetate)

Depo-Provera is an injectable progestin given every 3 months. Like Norethindrone, it works by suppressing ovulation and reducing endometrial growth.

Key facts about Depo-Provera:

• How it's given: Intramuscular injection every 12–13 weeks
• Cost: Around $50–$150 per injection
• Pros: Affordable, only needed every 3 months, also serves as birth control
• Cons: Can cause weight gain, irregular bleeding, mood changes, and bone density loss with long-term use. Requires office visits for injections.

How to Decide Which Alternative Is Right for You

The best alternative depends on your specific situation, including:

• The severity of your endometriosis symptoms
• Your insurance coverage and budget
• Whether you prefer oral medication or are okay with injections
• Your bone health history
• Whether you're planning to become pregnant in the near future

Talk to your OB/GYN or reproductive endocrinologist about which option makes the most sense for you. They can weigh the pros and cons based on your medical history.

Final Thoughts

Orilissa is a powerful tool for managing endometriosis pain, but it's not the only option. Whether you're dealing with availability issues, insurance roadblocks, or cost concerns, there are real alternatives that can help.

If you'd still like to try to find Orilissa, use Medfinder to search for pharmacies that have it in stock, or read our article on how to find Orilissa near you. And if cost is the main barrier, check out how to save money on Orilissa in 2026.