The Effect of Gonadotrophin-Releasing Hormone Agonist on Bone Mineral Density in Endometriosis:A Systematic Review

Objective:To determine the effect of gonadotrophin-releasing hormone agonist(GnRH-a) on the bone mineral density in women with endometriosis.Methods: A search for relevant articles was run on Cochrane Library,MEDLINE,EMBASE,CBM、CNKI et al database.Randomized controlled trials(RCTs) of patients with endometriosis treated with GnRH-a were included.Meta-analysis was performed by RevMan 4.2.10 software.Results: ①The reduce of BMD and the rate of bone loss were higher in the GnRH-a group than these in the add-back therapy group [RR=0.03;95%CI(0.01,0.06) P0.05]、[RR=1.86;95%CI(1.11,2.61) P0.01].The remaining descriptive study supported these results which indicated there was significant statistic difference between these two groups(P0.05).The BMD was decreased in the GnRH-a group compared with progestagens group(P0.05).②The side effect was more and the serum E2 level was also declined in the GnRH-a group compared with the add-back therapy group(P0.05).There was no statistic difference in pelvic pain compared with the add-back therapy group(P0.05).There was no difference in the pelvic pain and the drug side effect in the GnRH-a group compared with progestagens group.Conclusions: In GnRH-a group,the effect which releasing pelvic pain in endometriosis is the same as in the add-back therapy group and progestagens group.The decrease of BMD is higher in GnRH-a group than that in progestagens group.Add-back therapy can alleviate the BMD decrease and hot flush induced by GnRH-a,which provide a favorable project to long-term and reduplicated therapy.The evidence is not strong enough because of the low quality and small sample in the selected studies.Much more large-scale,multi-center,randomized,double-blinded,controlled clinical trials are required in the future.