Riscos e benefícios do uso a longo prazo de análogos do GnRH e terapia add back em mulheres com endometriose
article
OA: diamond
CC0
Abstract
Endometriosis is a highly prevalent disease that has several clinical repercussions, such as pain and infertility. In the management of the disease, combined oral contraceptives, intrauterine systems, anti-inflammatories, surgeries, and also GnRH analogues can be used. However, the current recommendation is that the use of GnRH analogues be for a period of up to six months. Objective: Analyze the risks and benefits of using GnRH analogues associated with add-back therapy (hormonal therapy with estrogens and progestins) for a period of more than six months in patients with endometriosis. Methods: A systematic review was carried out searching for articles in the PUBMED, Scopus, and Web of Science databases, using the descriptors “Gonadotropin-Releasing Hormone”, “GnRH”, “Endometriosis” and “Hormone Replacement Therapy”. Results: Eight studies were selected, which used GnRH analogues (leuprolide or goserelin or triptorelin) for at least 12 months, associated with add-back therapy (tibolone or norethindrone and estrogens or promegestone and estradiol). The average age of the participants ranged from 17.9 to 37.2 years. Pain control was observed in most studies (six), and no significant bone loss was demonstrated with the therapy. Conclusion: The studies suggest the safety of prolonged use of GnRH analogues, despite the bone mass loss.
Full text
6,815 characters
· extracted from
oa-doi-fallback
· click to expand
Riscos e benefícios do uso a longo prazo de análogos do GnRH e terapia add back em mulheres com endometriose
DOI:
https://doi.org/10.11606/issn.2176-7262.rmrp.2025.222864Palavras-chave:
Endometriose, Hormônio liberador de gonadotropina, Terapia de reposição de hormônios, Dor pélvicaResumo
A endometriose é uma doença de alta prevalência e que tem diversas repercussões clínicas como dor e infertilidade. No seu manejo pode-se dispor de contraceptivos orais combinados, sistema intrauterino, anti-inflamatórios, cirurgias e também análogos de GnRH. Contudo, a recomendação atual é que o uso de análogos de GnRH seja pelo período de até seis meses. Objetivo: analisar os riscos e benefícios da utilização de análogos de GnRH associados a terapia add -back (terapia hormonal com estrógenos e progestágenos) por um período superior a seis meses em pacientes com endometriose. Métodos: foi realizada uma revisão sistemática com busca de artigos nas bases PUBMED, Scopus e Web of Science, utilizando os descriptores “Gonadotropin-Releasing Hormone”, “GnRH”, “Endometriosis” e “Hormone Replacement Therapy”. Resultados: Foram selecionados oitos estudos, que usaram análogos de GnRH (leuprolida ou gosserrelina ou triptorrelina) por no mínimo 12 meses, associados a terapia add back (tibolona ou noretindrona e estrogênios ou promegestone e estradiol). A média de idade das participantes variou de 17,9 a 37,2 anos. O controle da dor foi observado na maioria dos estudos (seis) e neles não foi demonstrado perda óssea significativa com a terapia. Conclusão: o tratamento com análogos de GnRH e terapia add back, por mais de seis meses e até um ano, é efetivo no controle da dor e está associado a uma melhora da qualidade de vida. Além disso, mostrou-se seguro, não levando a comprometimento ósseo significativo.
Downloads
Referências
1. Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO). Endometriose. São Paulo: FEBRASGO, 2021 (Protocolo FEBRASGO-Ginecologia, n. 78/ Comissão Nacional Especializada em Endometriose).
2. GIUDICE, L. C. Clinical practice. Endometriosis. The New England Journal of Medicine, v. 362, n. 25, p. 2389–2398, 24 jun. 2010.
3. BULUN, S. E. Endometriosis. The New England Journal of Medicine, v. 360, n. 3, p. 268–279, 15 jan. 2009.
4. NAVARRO, P. A. DE A. S.; BARCELOS, I. D. S.; ROSA E SILVA, J. C. Tratamento da endometriose. Revista Brasileira de Ginecologia e Obstetrícia, v. 28, p. 612–623, out. 2006.
5. FERNANDEZ, C. F. R. P. Endometriose profunda : achados clínicos, epidemiológicos e ultrassonográficos. Dissertação (Mestrado em Cirurgia) – Universidade Federal de Pernambuco, Recife, 2022.
6. ZHENG, Q. et al. Can postoperative GnRH agonist treatment prevent endometriosis recurrence? A meta-analysis. Archives of Gynecology and Obstetrics, v. 294, n. 1, p. 201– 207, jul. 2016.
7. SANTOS, C. M. DA C.; PIMENTA, C. A. DE M.; NOBRE, M. R. C. A estratégia PICO para a construção da pergunta de pesquisa e busca de evidências. Revista Latino- Americana de Enfermagem, v. 15, p. 508–511, jun. 2007.
8. KIM, N. Y. et al. The efficacy and tolerability of short-term low-dose estrogen-only add- back therapy during post-operative GnRH agonist treatment for endometriosis. European Journal of Obstetrics, Gynecology, and Reproductive Biology, v. 154, n. 1, p. 85–89, jan. 2011.
9. MAHER, C. G. et al. Reliability of the PEDro Scale for Rating Quality of Randomized Controlled Trials. Physical Therapy, V. 83, p. 713–721, ago. 2003.
10. AL-AZEMI, M. et al. Immediate and delayed add-back hormonal replacement therapy during ultra long GnRH agonist treatment of chronic cyclical pelvic pain. BJOG: an international journal of obstetrics and gynaecology, v. 116, n. 12, p. 1646–1656, nov. 2009.
11. ALSHEHRE, S. M. et al. A prospective, single-centre, single-arm, open label study of the long term use of a gonadotropin releasing hormone agonist (Triptorelin SR, 11.25 mg) in combination with Tibolone add-back therapy in the management of chronic cyclical pelvic pain. Reproductive biology and endocrinology: RB&E, v. 18, n. 1, p. 28, 14 abr. 2020.
12. DIVASTA, A. D. et al. Hormonal Add-Back Therapy for Females Treated With Gonadotropin-Releasing Hormone Agonist for Endometriosis: A Randomized Controlled Trial. Obstetrics and Gynecology, v. 126, n. 3, p. 617–627, set. 2015.
13. FERNANDEZ, H. et al. One year comparison between two add-back therapies in patients treated with a GnRH agonist for symptomatic endometriosis: a randomized double-blind trial. Human Reproduction (Oxford, England), v. 19, n. 6, p. 1465–1471, jun. 2004.
14. HORNSTEIN, M. D. et al. Leuprolide acetate depot and hormonal add-back in endometriosis: a 12-month study. Lupron Add-Back Study Group. Obstetrics and Gynecology, v. 91, n. 1, p. 16–24, jan. 1998.
15. PIERCE, S. J.; GAZVANI, M. R.; FARQUHARSON, R. G. Long-term use of gonadotropin-releasing hormone analogs and hormone replacement therapy in the management of endometriosis: a randomized trial with a 6-year follow-up. Fertility and Sterility, v. 74, n. 5, p. 964–968, nov. 2000.
16. SURREY, E. S.; HORNSTEIN, M. D. Prolonged GnRH agonist and add-back therapy for symptomatic endometriosis: long-term follow-up. Obstetrics and Gynecology, v. 99, n. 5 Pt 1, p. 709–719, maio 2002.
17. HORNSTEIN, M. D. et al. Use of nafarelin versus placebo after reductive laparoscopic surgery for endometriosis. Fertility and Sterility, v. 68, n. 5, p. 860–864, nov. 1997.
18. SURREY, E. S. et al. Prolonged gonadotropin-releasing hormone agonist treatment of symptomatic endometriosis: the role of cyclic sodium etidronate and low-dose norethindrone “add-back” therapy. Fertility and Sterility, v. 63, n. 4, p. 747–755
19. CASHIN, A. G.; MCAULEY, J. H. Clinimetrics: Physiotherapy Evidence Database (PEDro) Scale. Journal of physiotherapy, vol. 66, n1, p.59, jan 2020.
20. KUZNETSOV, L. et al. Guideline Committee. Diagnosis and management of endometriosis: summary of NICE guidance. BMJ (Clinical research ed.), v. 358, set 2017.
21. BROWN, J.; PAN, A; HART, R.J. Gonadotrophin-releasing hormone analogues for pain associated with endometriosis. Cochrane Database Syst Rev. n12, dez 2010
22. HORNE, A. W.; MISSMER, S. A. Pathophysiology, diagnosis, and management of endometriosis. BMJ (Clinical research ed.), v.379, nov 2022
23. WU, D. et al. Clinical efficacy of add-back therapy in treatment of endometriosis: a meta-analysis. Arch Gynecol Obstet. v. 290, p. 513-523, set 2014.
24. BECKER, C.M. et al. ESHRE Endometriosis Guideline Group, ESHRE guideline: endometriosis. Human Reproduction Open, v. 2022, n.2, fev 2022.
Downloads
Publicado
Edição
Seção
Licença
Direitos autorais (c) 2025 Ana Vitória Meireles Veiga, Leonam Costa Oliveira
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
Text is read by the "Ask this paper" AI Q&A widget below. Extraction quality varies by source — PMC NXML preserves structure cleanly, OA-HTML may include some navigation residue, and OA-PDF can have broken hyphenation. The publisher copy (via DOI) is the canonical version.
My notes (saved in your browser only)
Ask this paper
Answers must be backed by verbatim quotes from this paper's full text. Hallucinated quotes are dropped automatically; if no verbatim passage answers the question, we say so. How this works
Condition tags
Citation neighborhood (no data yet)
We don't have any in-corpus citations linked to this paper yet. This is a recent paper (2026) — citers typically take a year or two to land, and the OpenAlex reference graph may still be filling in.
Source provenance
- openalex
- last seen: 2026-06-10T17:14:06.276822+00:00
License: CC0
· commercial use OK