{"paper_id":"429a0f14-03fc-46b6-a529-8d9cb23743d5","body_text":"Acta Med Kinki Univ Vol. 37, No. 2 99-101, 2012\nSevere  endometriosis treated with long-term GnRHa :\ncase report\nYasushi Kotani, Mitsuru Shiota, Masahiko\nand\nUmemoto,\nHiroshi Hoshiai\nTakako Tobiume, Koshiro Obata\nDepartment of Obstetrics and Gynecology, Kinki University Faculty\nOsakasayama, Osaka 589-8511, Japan\nof Medicine,\nAbstract\n   Gonadotrophin-releasing hormone agonist \n(GnRHa) therapy for endometriosis is rarely \nused for long periods of time because it leads to \ndecreased bone density and menopausal syn-\ndrome. Here, we describe a patient with severe \nendometriosis who underwent a colostomy and \nhysterectomy at a young age and has been on \nGnRHa therapy for 13 years since the surgery. \n   The patient is a 37-year-old GOPO woman \nwho underwent a colostomy for ileus of the \nsigmoid colon and rectal endometriosis at the \nage of 21 years. At the age of 22 years, she \nunderwent total abdominal hysterectomy, choco-\nlate cystectomy, and partial rectectomy. After\nthe surgery, her ovarian endometrioma recurred \nand ureteral endometriosis developed. She was \nthen started on GnRHa therapy and has been on \ncontinuous therapy for 13 years up to the pres-\nent. Side effects as such as decreased bone \nmineral density and menopausal syndrome have \nnot been observed. Although GnRHa therapy is \ngenerally not used chronically because of its side \neffects, it has been possible to use it in this \npatient over a long period of time by ongoing \nmonitoring for the development of deleterious \nside effects and adjusting the dose as needed. \nKey words : endometriosis, ovarian cyst, \ngonadotropin-releasing hormone\nIntroduction\n Endometriosis is characterized by the presence \nof endometrium-like lesions outside the uterine \ncavity. This condition is an estrogen-dependent \ndisease that occurs in 10% of women of reproduc-\ntive age and regresses after the menopause or \novariectomy. The main symptoms are pelvic \npain, including dysmenorrhea, chronic pelvic \npain and deep dyspareunia and infertility. \n In gynecological practice, gonadotropin-\nreleasing hormone agonist (GnRHa) therapy is \noften used for endometriosis. Continuous \nadministration of GnRHa leads to downregula-\ntion of the expression of GnRH receptors and the \nconsequent suppression of luteinizing hormone \nand follicle-stimulating hormone secretion. The \nresult is a state of low estrogen, so that GnRHa \ntherapy is called pseudo-menopausal therapy.\nThe efficacy of GnRHa therapy against the pain \nof endometriosis and ovarian endometrioma has \nbeen reported,' but because long-term GnRHa \ntherapy may lead to decreased bone mineral \ndensity and menopausal syndrome, it is not used \nfor chronic therapy.2°3 There have been recent \nreports on therapies to reduce the adverse side \neffects of GnRHa while maintaining its therapeu-\ntic efficacy, such as \"add-back\" therapy, which \nadministers small doses of estrogen-progestin, \nand \"draw-back therapy\", which administers \nGnRHa at longer intervals.4,5 To the best of our \nknowledge, although there are reports of the \nlong-term use of GnRHa using these methods, \nthere is no published report on the use of \nGnRHa therapy for 10 years or longer without \nusing these methods. \n In this report, we describe a patient with severe \nendometriosis who needed a colostomy and\nReceived October 4, 2011 ; Accepted November 18, 2011\n\n\nö\n워\nö\nö\nЖ ö\nö\nö\nЖ ö\nöö\nö\nЖ ö\nö\nö\nö\nö 워\nö ˢ\nЖ ö\nö\nö\nö 워\nЖ ö\n\u0012\u0011\u0011\n\n원웦웑\nЖ\nЖ ö 웍\n웎웦웏웦웒\nЖ ö\nЖ ö\n웓\nõ\nõ\nô\nõ\nô\nõ\nô\nõ\nô\nõ ㅤ\nô\nõ\nô\nõ\nô\nõ\nô\n\u0012\u0011\u0012","source_license":"CC0","license_restricted":false}