EFFECT OF ADD-BACK HORMONE REPLACEMENT THERAPY WITH GONADOTROPIN-RELEASING HORMONE AGONIST FOR TREATMENT OF ENDOMETRIOSIS
Khaled Abdel Malek, Ahmed S. Nasr, Osama A Shawki
Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University
Objective: Assessment of the effect of add-back estrogen-progestin therapy on vasomotor symptoms and bone loss associated with GnRH agonist therapy in cases of endometriosis.
Materials and methods: This is a prospective, randomized, clinical placebo-controlled, double-blind, trial including 36 women with endometriosis confirmed by laparoscopy treated with goserelin acetate. They were randomly assigned in equal 2 groups; group (1) received combination of 1 mg norethisterone acetate and conjugated equine estrogens 1.25 mg and group (2) received an oral placebo daily for 24 weeks. Second-look laparoscopy was done to assess response of endometriosis: endometrial thickness was measured by transvaginal ultrasonography. Bone mineral density was measured using dual energy x-ray absorptiometry. The menopause rating scale (MRS) was used to characterize climacteric symptoms.
Results: the two studied groups were matched for age, body mass index and hemodynamic characteristics. There was a significant reduction of the endometriosis score in the two groups, with no significant difference between the two groups before (p = 0.837) and after treatment (p = 0.505). After treatment, bone mineral density decreased by 5.45% in the placebo group and 0.76% in the add-back group (p < 0.001). In the add-back group mild but not significant rise in the MRS was observed after 12 and 24 weeks
Conclusion: the addition of add-back HRT for GnRH agonists in treatment of endometriosis reduces the hypoestrogenic effects of the latter, preserves bone mineral density and diminishes the unwanted vasomotor effects of the drug.