Gonadotropin-Releasing Hormone Analogues for the Treatment of Endometriosis: Long-Term Follow-up

Gonadotropin-Releasing Hormone Analogues for the Treatment of Endometriosis: Long-Term Follow-up - Kathleen G. Waller - Robert W. Shaw Gonadotropin-releasing hormone analogues (GnRH-a) were first used in the treatment of endometriosis in 1982. Large-scale clinical trials with these agents have now been completed. All of the analogue studies have shown them to be as effective as danazol in reducing endometriosis growth and symptoms during treatment, and preventing the return of symptoms during the 6− to 12-month follow-up. There have been no reports in the literature discussing longer-term follow-up of patients treated with GnRH-a. One of this study's objectives was to determine the long-term recurrence rate of endometriosis after treatment with GnRH-a. This was a historical perspective study conducted in a tertiary referral center in London. Between 1985 and 1987, 130 patients with laparoscopically proven endometriosis underwent medical treatment with various GnRH-a drugs. Patients underwent treatment for 6 months, and most had a second-look laparoscopy. Patients were followed up routinely at 6-month intervals for 2 years as part of the study protocol. Further follow-up was obtained by review of gynecologic clinic records or postal questionnaire with their general practitioners. Recurrence of disease in this study was characterized as either a documented recurrence or an undocumented recurrence. A documented recurrence was defined as visually diagnosed active disease at laparoscopy, or histologically proven disease at laparotomy. Undocumented recurrence consisted of return of symptoms sufficient to require empiric retreatment without laparoscopy. This treatment was initiated by either a gynecologist or general practitioner. The cumulative recurrence rate for the 5th year after treatment ended was 53.4 per cent (fig. 1). Patients with higher disease stage at enrollment in the study were more likely to experience recurrence, and experience it earlier, than patients with minimal disease. Fifth-year recurrence rates were 36.9 per cent for minimal disease, and 74.4 per cent for severe disease. Sixty-nine patients in the study complained of infertility. Twenty-two women became pregnant spontaneously after completing treatment, and 18 women had a live birth. Of the four women who miscarried, three became pregnant again and had live birth within the study period.