Treatment of endometriosis with a long-acting gonadotropin-releasing hormone agonist plus medroxyprogesterone acetate.
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Adding medroxyprogesterone acetate to a GnRH agonist in women with endometriosis reduced hypoestrogenic effects but did not improve pain or endometriotic implants.
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Abstract
Highly potent agonists of gonadotropin-releasing hormone (GnRH) have been shown to reduce pelvic pain due to endometriosis and the size and number of implants seen at laparoscopy. The accompanying symptoms and problems associated with the hypoestrogenism induced by the agonist have reduced its acceptability and raised questions about its safety. In an attempt to optimize this form of therapy, we treated eight women with endometriosis with daily subcutaneous injections of a potent agonist of GnRH plus a daily oral dose of 20-30 mg of medroxyprogesterone acetate for 24 weeks. Ovarian estrogen secretion was reduced to levels seen in castrated women throughout the course of treatment. Markers of hypoestrogenism, such as hot flashes and loss of calcium from bone, were diminished with this regimen compared with previous findings with GnRH agonist alone. Blinded evaluation of laparoscopic photographs failed to reveal improvement or suppression of active endometriosis. The results of this pilot study indicate that the addition of medroxyprogesterone acetate decreases the hypoestrogenic effects of GnRH agonist alone but fails to affect pain or endometriotic implants.
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Cited by (49)
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- Endometriosis: A general review and rationale for surgical therapy 2006
- Medical Management of Endometriosis 2006
- Hormone therapy for endometriosis and surgical menopause 2006
- GnRH-antagonists in reproductive medicine 2005
- Emerging drugs for endometriosis 2004
- Extraperitoneal endometriosis with catamenial pneumothoraces: a review of the literature. 2004
- Diagnosis and treatment of endometriosis 2003
- Hormone Replacement Therapy for “At Risk” Patients with Connective Tissue Diseases 2001
- UPDATE ON THE MEDICAL TREATMENT OF ENDOMETRIOSIS 2000
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- Treatment of endometriosis with a decreasing dosage of a gonadotropin-releasing hormone agonist (nafarelin): a pilot study with low-dose agonist therapy (“draw-back” therapy) 2000
- Add-back therapy and gonadotropin-releasing hormone agonists in the treatment of patients with endometriosis: can a consensus be reached? 1999
- GnRH analogueによる子宮内膜症治療における結合型エストロゲンを用いたadd-back療法の検討 1999
- Endometriosis and Pelvic Pain 1998
- GnRH agonists and add‐back therapy: is there a perfect combination? 1998
- Leuprolide Acetate Depot and Hormonal Add-Back in Endometriosis: A 12-Month Study 1998
- Add-Back Therapy: Extending Safety and Efficacy of GnRH Analogues in the Gynecologic Patient 1998
- MODERN MEDICAL MANAGEMENT OF ENDOMETRIOSIS 1997
- Medroxyprogesterone acetate supplementation diminishes the hypoestrogenic side effects of gonadotropin-releasing hormone agonist without changing its efficacy in endometriosis 1996
- The effect of add-back treatment with tibolone (Livial) on patients treated with the gonadotropin-releasing hormone agonist triptorelin (Decapeptyl) 1996
- Endometriosis: An Enigmatic Disease 1996
- Pain recurrence: A quality of life issue in endometriosis 1995
- Endometriosis: Current Management 1995
- Nafarelin therapy in endometriosis: Long-term effects on bone mineral density 1994
- Uses of GnRH Agonists 1994
- Medical management of endometriosis 1993
- Changing concepts of medical treatment of endometriosis 1993
- Gonadotropin-releasing hormone agonist plus estrogen-progestin “add-back” therapy for endometriosis-related pelvic pain 1993
- 9 Endometriosis: Medical therapy 1993
- Report on a conference on developments in the treatment of benign gynecological disorders 1992
- Hormone treatment of endometriosis: The estrogenthreshold hypothesis 1992
- Principles of medical therapy for endometriosis pain 1992
- Gonadotropin-releasing hormone agonists: Strategies formanaging the hypoestrogenic effects of therapy 1992
- Gonadotropin releasing hormone agonist treatment for severe menorrhagia in patients with contraindications to surgery 1992
- The potential for the use of GnRH agonists for treatment of dysfunctional uterine bleeding 1992
- Spontaneous and steroid-induced recurrence of endometriosis after suppression by a gonadotropin-releasing hormone antagonist in the rat 1991
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