Clinical efficacy of add-back therapy in treatment of endometriosis: a meta-analysis

Debin Wu, Min Hu, Li Hong, Shasha Hong, Wenjuan Ding, Jie Min, Gui Fang, Wenjun Guo
Archives of gynecology and obstetrics · 2014 · vol. 290(3) , pp. 513–523 · doi:10.1007/s00404-014-3230-8 · PMID:24728145 · W2006628041
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-06 ⓘ

Add-back therapy with GnRH analogues for endometriosis was more effective for symptom relief and preserved bone mineral density compared to GnRH analogues alone.

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This meta-analysis evaluated the effectiveness of gonadotropin-releasing hormone analogues (GnRH-a) with versus without hormonal add-back therapy for treating endometriosis, using a search of Cochrane Library, Ovid (Embase), and PubMed for prospective randomized controlled trials published between 1998 and 2013. Thirteen RCTs totaling 945 participants were included, with outcomes including bone mineral density at baseline after treatment and at 6 months, serum estradiol, and symptom measures such as Kupperman index, pelvic pain (dysmenorrhoea and dyspareunia), and pelvic tenderness. The results indicated add-back therapy provided greater symptom relief than GnRH-a alone, significantly altered BMD in comparison with GnRH-a alone, increased serum oestrogen, and did not reduce GnRH-a’s efficacy for dysmenorrhoea and dyspareunia; no statistically significant differences were found among different add-back regimens. This paper is centrally about endometriosis—specifically, it meta-analyzes how add-back hormonal regimens modify GnRH-a efficacy and side-effect profiles in endometriosis treatment.

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Abstract

Objective A meta-analysis was conducted to determine the effectiveness of using gonadotropin-releasing hormone analogues (GnRH-a), both with and without hormonal add-back therapy, for the management of endometriosis.

Methods

Cochrane library, Ovid (Embase) and Pubmed databases were searched between the years 1998 and 2013 for published, prospective, randomised controlled trials (RCT) that assessed the effectiveness of “add-back” therapy for EMs treatment. The meta-analysis was performed using RevMan V5.0. The main outcome measures were as follows: lumbar spine bone mineral density (BMD) immediately after treatment and after 6 months of follow-up; femoral neck BMD; serum estradiol levels; changes in the Kupperman index score; the pelvic pain score, including dysmenorrhoea and dyspareunia; and pelvic tenderness.

Results

A total of 13 RCT, including 945 participants, were identified. The evidence suggested that “add-back” therapy was more effective for symptom relief than GnRH-a alone. BMD was significantly different when comparing “add-back” therapy to GnRH-a alone, both immediately after treatment and at 6 months. The “add-back” therapy increased serum oestrogen and did not reduce the efficacy of GnRH-a for treating dysmenorrhoea and dyspareunia. A variety of add-back regimens had a same effect for the treatment of endometriosis.

Conclusions

“Add-back” therapy, based on the GnRH-a dose, does not reduce the efficacy of using GNRH-a for the management of endometriosis. “Add-back” therapy reduced the occurrence of side effects that can occur with GnRH-a therapy alone, such as osteoporosis and menopausal syndrome. There were no statistically significant differences when comparing the effectiveness of a variety of “add-back” regimens to each other. Similar content being viewed by others

References

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Zhonghua Fu Chan Ke Za Zhi 48(5):338–343 Cheung TH, Lo KW, Yim SF et al (2005) Dose effects of progesterone in add-back therapy during GnRHa treatment. J Reprod Med 50(1):35–40 Guzick DS, Huang LS, Broadman BA et al (2011) Randomized trial of leuprolide versus continuous oral contraceptives in the treatment of endometriosis-associated pelvic pain. Fertil Steril 95(5):1568–1573 Conflict of interest The authors declare that they have no conflict of interest. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Wu, D., Hu, M., Hong, L. et al. Clinical efficacy of add-back therapy in treatment of endometriosis: a meta-analysis. Arch Gynecol Obstet 290, 513–523 (2014). https://doi.org/10.1007/s00404-014-3230-8 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00404-014-3230-8

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Condition tags

mesh:D004412mesh:D004414mesh:D004715endometriosis

MeSH descriptors

Endometriosis Gonadotropin-Releasing Hormone Hormone Replacement Therapy Uterine Diseases Bone Density Bone Density Dose-Response Relationship, Drug Dysmenorrhea Dysmenorrhea Dyspareunia Dyspareunia Endometriosis Estrogens Estrogens Female Femur Neck Femur Neck Gonadotropin-Releasing Hormone Humans Lumbar Vertebrae

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