Should add-back therapy for endometriosis be deferred for optimal results?
RCT
OA: closed
CC0
⤵ 30 in-corpus citations
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This trial found that immediate add-back therapy with medrogestone for endometriosis patients receiving goserelin did not show significant differences in efficacy or bone mineral density loss compared to deferred add-back therapy.
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Abstract
Add-back hormone replacement therapy has been shown to alleviate some of the hypo-oestrogenic side effects associated with gonadotrophin-releasing hormone agonists, including demineralisation of bone. Studies on patients with uterine fibroids have shown that concomitant add-back therapy reduced the efficacy of these agents, but that deferred administration was less detrimental. This trial set out to investigate if deferred add-back therapy could offer any advantages to patients with endometriosis compared with immediate therapy. Zoladex [goserelin acetate (3.6 mg every 4 weeks)] was given for 24 weeks either with placebo, with medrogestone (10 mg/day) for 24 weeks (immediate add-back therapy), or with placebo for 12 weeks followed by medrogestone (10 mg/day) for 12 weeks (deferred add-back therapy) to 123 patients. The number of responders measured using the Revised American Fertility Society score (decrease in this score of > or = 50%) was greatest in the immediate add-back therapy group, although there were no significant differences between groups. All three treatment groups showed significant decreases in bone mineral density compared with baseline but smaller losses were generally observed in the add-back groups. A significantly smaller number of patients in the immediate add-back group reported hot flushes during the first 12 weeks of treatment compared with the deferred add-back group. In conclusion, it appears that there is no extra advantage to patients with endometriosis being treated with goserelin in delaying the start of add-back therapy.
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Cited by (28)
- Evaluation, validation and refinement of noninvasive diagnostic biomarkers for endometriosis (ENDOmarker): A protocol to phenotype bio-specimens for discovery and validation 2018
- Hormonal Add-Back Therapy for Females Treated With Gonadotropin-Releasing Hormone Agonist for Endometriosis: A Randomized Controlled Trial 2015
- Treatment of pelvic pain associated with endometriosis: a committee opinion 2014
- [Medical treatments of presumed benign ovarian tumors] 2013
- Medikamentöse Therapie der chronischen Endometriose 2011
- Common problems in pediatric and adolescent gynecology 2010
- Gonadotropin-releasing hormone agonist and add-back therapy: what do the data show? 2010
- Bone density in adolescents treated with a GnRH agonist and add-back therapy for endometriosis 2007
- GnRH-Analoga in der Endometriosetherapie 2006
- GnRH agonist and antagonist: Options for endometriosis pain treatment 2006
- GnRH analogs: options for endometriosis-associated pain treatment 2006
- The relevancy of the matrix metalloproteinase system to the pathophysiology of endometriosis 2005
- Novel targets for the treatment of endometriosis 2004
- Medical management of endometriosis: novel targets and approaches towards the development of future treatment regimes 2003
- Gonadotrophin-releasing hormone analogues for endometriosis: bone mineral density 2003
- Adolescent endometriosis: diagnosis and treatment approaches 2003
- Rezidivierende Endometriose?ein Kofaktor der vorzeitigen Menopause? 2003
- Use of GnRH antagonists in the treatment of endometriosis 2002
- HRT as add-back therapy 2002
- Medikamentöse Therapie der Endometriose mit GnRH-Antagonisten 2002
- Will GnRH antagonists assist in the treatment of benign gynaecological diseases? 2002
- Treating endometriosis as an autoimmune disease 2001
- Delayed oral estradiol combined with leuprolide increases endometriosis-related pain 2000
- Individualized therapy of sterility caused by endometriosis 1999
- GnRH agonists and add-back therapy: is there a perfect combination? 1998
- Steroidal 'add-back' therapy in patients treated with GnRH agonists 1998
- The evidence for the management of endometriosis 1998
- Hormone replacement therapy following hysterectomy for endometriosis 1998
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- europepmc
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- openalex
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- pubmed
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