Add-Back Therapy: Extending Safety and Efficacy of GnRH Analogues in the Gynecologic Patient

Eric S. Surrey, E S Surrey
Gynecologic and obstetric investigation · 1998 · vol. 45(Suppl. 1) , pp. 31–34 · doi:10.1159/000052849 · PMID:9628522 · W2014270274
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⚙ AI-generated summary by claude@2026-06, 2026-06-06 ⓘ

Add-back therapy with norethindrone acetate alone or with conjugated equine estrogens, or with norethindrone and a bisphosphonate, reduces side effects and preserves bone density to allow extended GnRH analogue use for endometriosis.

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Abstract

GnRH analogues have been demonstrated to be effective medical therapy for symptomatic endometriosis. The use of these agents has been limited to 6 months due to hypoestrogenic side effects. A variety of steroidal and nonsteroidal add-back regimens have been used in an effort to eliminate such side effects while maintaining efficacy in order to enhance compliance, safety and duration such side effects while maintaining efficacy in order to enhance compliance, safety and duration of administration of these agents. Only 3 regimens have been shown to be efficacious in prolonging analogue use beyond 6 months by reducing vasomotor symptoms as well as preventing significant bone mineral density loss. These include daily norethindrone acetate 5 mg alone or in conjunction with conjugated equine estrogens 0.625 mg daily, as well as norethindrone 2.5 mg daily in conjunction with an organic bisphosphonate. With further investigation, such regimens may allow safe prolongation of GnRH analogue use without sacrificing efficacy in those endometriosis patients with severe pelvic pain.

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Condition tags

endometriosis

MeSH descriptors

Estrogens Genital Diseases, Female Gonadotropin-Releasing Hormone Gonadotropin-Releasing Hormone Endometriosis Endometriosis Estrogens Estrogens, Conjugated (USP) Estrogens, Conjugated (USP) Estrogens, Conjugated (USP) Female Genital Diseases, Female Gonadotropin-Releasing Hormone Humans Norethindrone Norethindrone Norethindrone Norethindrone Norethindrone Acetate

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (17)

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