Development of a GnRHa injection regime for patients with severe endometriosis after laparoscopic surgery

Objective To develop an injection regime of gonadotropin releasing hormone agonist (GnRHa) in patients with severe endometriosis (EM) after laparoscopic surgery. Methods 32 severe EM patients after laparoscopic surgery were administered with Triptorelin 3.75 mg subcutaneously using either a classical regime (control group, n=17, 6 doses with an interval of 4 weeks between two consecutive injections) or a modified regime (observation group,n=15, 4 doses with an interval of 6 weeks between two consecutive injections). The concentrations of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and the occurrence rate of menopausal symptoms , changes of lumbar vertebra density during GnRHa therapies were compared. The recurrence rate of EM and recovery of lumbar vertebra density at 2 years after laparoscopic surgery were also compared. Results The levels of FSH, LH, and E2 in both the patients and the control subjects were significantly decreased after the treatment (P0.05). The level of reduction in the observation group was greater than the control group (P 0.05). The occurrence rate of menopausal symptoms in the control group was significantly higher than the observation group (58.8% vs 13.3%, χ2 =7.036,P0.05) in their second half phases of the treatment. After treatment ,the lumbar vertebra density in the observation group did not change obviously, but the lumbar vertebra density of the control group was significantly decreased compare with before treatment (P0.05). The rate of recurrence of EM in the observation group (6.7%, 1 case) was similar to the control group (11.8%, 2 cases) (χ2 =0.244, P0.05). Low lumbar vertebra density was still observed in the control patients two years after surgery. Conclusions The modified GnRHa administration regime with a longer interval of injection was found to be effective. It could relieve the excessive suppression of pituitary and ovary.