The effect of GnRHa combined with add-back therapy in the treatment of patients with moderate /severe endometriosisafter conservative surgery:a meta-analysis

Objective To evaluate the effect of gonadotropin-releasing hormone agonist( Gonadotrophin releasing hormone agonist,GnRHa) combined with add back therapy for moderate / severe endometriosis after conservative surgery in China. Methods In addition to manually searching,Cochrane CentralRegister of Controlled Trials( CENTRAL),the Cochrane Library,PubMed,Medline,EMBASE,SCI,Chinese journal full-text database,Chinese biomedical literature database,Chinese sci-tech periodical full-text database,VIP Chinese Periodical Database and Wanfang Chinese Periodical Database were electronically searched from the establsihment of the database till March 2013,and state was limit as China. A total of seven RCTs meet the criteria. The data was extracted and analyzed by two reviewers independently using the RevMan5. 1 software. Results ①The increase in serum estrogen( E2) levels,P 0. 01,decrease in levels of serum follicle-stimulating hormone( FSH) was observed in the add-back therapy group,P= 0. 006,there was no statistic difference in the levels of serum CA125 and LH between the add-back therapy group and the GnRHa group,P 0. 05. ②There was no significant difference in the VAS score between the add-back therapy group and the GnRHa group,P = 0. 12. ③The menopause symptom( Kupperman score) caused by GnRHa was relieved in the add-back therapy group,P = 0. 001,There was no statistic difference in the levels of serum BMD and BPG levels,P 0. 05. Conclusions GnRHa combined with add-back therapy post operation for moderate / severe endometriosis can effectively reduce the the menopause symptoms caused by GnRHa,with no evidence of changes in bone density,pain symptoms and CA125 levels.