Immediate and delayed add-back hormonal replacement therapy during ultra long GnRH agonist treatment of chronic cyclical pelvic pain

Majedah Al‐Azemi, M Al-Azemi, Georgina Jones, G Jones, F Sirkeci, Füsun Sirkeci, Stephen J. Walters, S Walters, M Houdmont, William J. Ledger, W Ledger
BJOG: An International Journal of Obstetrics & Gynaecology · 2009 · vol. 116(12) , pp. 1646–1656 · doi:10.1111/j.1471-0528.2009.02319.x · PMID:19735378 · W1865102798
RCT OA: closed CC0 ⤵ 11 in-corpus citations
View on OpenAlex View on PubMed View at publisher
⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-06 ⓘ

This randomized trial found that immediate add-back hormonal replacement therapy during GnRH agonist treatment for pelvic pain preserved bone mineral density and reduced symptoms compared to delayed HRT, although long-term outcomes were similar.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

Abstract

OBJECTIVE: To assess the safety and efficacy of long-term use of long-acting GnRH agonist in women with chronic cyclical pelvic pain using immediate versus delayed add-back hormonal replacement therapy (HRT). DESIGN: A prospective randomised trial. SETTING: Reproductive and Developmental Medicine, Academic Unit, University Teaching Hospital and NHS Hospitals. POPULATION: Thirty-eight premenopausal women with chronic cyclical pelvic pain were recruited. METHODS: Women were given Zoladex 10.8 mg over 18 months and randomised to receive HRT (tibolone 2.5 mg) either immediately or after 6 months. Follow up was 12-month post-treatment. MAIN OUTCOME MEASURES: Bone mineral density at 6 months, the end of treatment (18 months), and 12 months later, pain and quality of life. RESULTS: Women treated with immediate HRT add-back showed less bone mineral density loss at 6 months and less vasomotor symptoms compared with those who had delayed HRT add-back treatment. Long-term follow up showed both groups experienced equivalent bone mineral density loss. Pain and health-related quality-of-life assessment showed improvement in both groups but there was evidence of a return to baseline levels after ending treatment. CONCLUSION: Long-term use of GnRH agonist plus immediate add-back HRT is a safe and acceptable approach to intractable cyclical pelvic pain. Given the delay in reactivation of the hypothalamo-pituitary-ovarian axis after long-term suppression, an intermittent dose regime with GnRH agonist might warrant investigation.

My notes (saved in your browser only)

MeSH descriptors

Estrogen Replacement Therapy Goserelin Norpregnenes Pelvic Pain Adult Bone Density Bone Density Chronic Disease Drug Administration Schedule Drug Therapy, Combination Estrogen Replacement Therapy Female Follow-Up Studies Gonadotropin-Releasing Hormone Gonadotropin-Releasing Hormone Goserelin Humans Middle Aged Norpregnenes Pain Measurement

Citation neighborhood (2-hop)

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. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

References (44)

Cited by (12)

Source provenance

openalex
last seen: 2026-05-11T06:20:36.346967+00:00
pubmed
last seen: 2026-10-08T21:06:50.232585+00:00
unpaywall
last seen: 2026-10-16T06:24:35.758740+00:00
License: CC0 · commercial use OK