Gonadotropin-releasing hormone agonist and add-back therapy: what do the data show?

Eric S. Surrey, Surrey ES
Current opinion in obstetrics & gynecology · 2010 · vol. 22(4) , pp. 283–288 · doi:10.1097/gco.0b013e32833b35a7 · PMID:20498596 · W2036733694
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Add-back therapy with progestins and/or low-dose estrogens effectively mitigates hypoestrogenic side effects of gonadotropin-releasing hormone agonists, improving compliance and allowing for prolonged treatment of endometriosis.

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This review examines the use of gonadotropin-releasing hormone agonists as primary medical therapy for symptomatic endometriosis, addressing the challenge of secondary hypoestrogenic side effects that often limit patient compliance. It highlights that add-back therapy using progestins with or without low-dose estrogens effectively extends treatment duration while minimizing adverse events such as vasomotor symptoms and bone loss. The authors emphasize that initiating add-back concurrently is crucial, particularly for adolescents who require careful monitoring of bone mineral density during prolonged therapy. This paper is centrally about endometriosis — specifically the management of symptomatic disease through GnRH agonist protocols combined with add-back regimens to improve efficacy and tolerability.

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Abstract

PURPOSE OF REVIEW: Endometriosis is a gynecologic disorder that can lead to debilitating chronic pelvic pain and infertility. Gonadotropin-releasing hormone agonists (GnRHa) have emerged as a primary medical therapy for patients with symptomatic disease, but secondary hypoestrogenic side effects may limit compliance. Add-back therapy is a means of surmounting this problem. RECENT FINDINGS: Progestins such as norethindrone acetate may be administered with or without addition of low doses of estrogens to safely and effectively extend GnRHa therapy while minimizing side effects. Recent studies have demonstrated that the use of add-back enhances compliance and duration of therapy. The initiation of an add-back should not be deferred given evidence demonstrating an increase in vasomotor symptoms and bone loss if not administered concomitantly. The subset of adolescents with endometriosis who require GnRHa therapy should be administered an add-back, but require careful monitoring of bone mineral density. SUMMARY: Implementation of an appropriately selected add-back will significantly reduce hypoestrogenic side effects, enhance compliance, and allow for prolongation of therapy without interfering with the efficacy of GnRHa in treating symptomatic endometriosis.
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Gonadotropin-releasing hormone agonist and add-back therapy: what do the data show? - Eric S Surrey Purpose of review Endometriosis is a gynecologic disorder that can lead to debilitating chronic pelvic pain and infertility. Gonadotropin-releasing hormone agonists (GnRHa) have emerged as a primary medical therapy for patients with symptomatic disease, but secondary hypoestrogenic side effects may limit compliance. Add-back therapy is a means of surmounting this problem. Recent findings Progestins such as norethindrone acetate may be administered with or without addition of low doses of estrogens to safely and effectively extend GnRHa therapy while minimizing side effects. Recent studies have demonstrated that the use of add-back enhances compliance and duration of therapy. The initiation of an add-back should not be deferred given evidence demonstrating an increase in vasomotor symptoms and bone loss if not administered concomitantly. The subset of adolescents with endometriosis who require GnRHa therapy should be administered an add-back, but require careful monitoring of bone mineral density. Summary Implementation of an appropriately selected add-back will significantly reduce hypoestrogenic side effects, enhance compliance, and allow for prolongation of therapy without interfering with the efficacy of GnRHa in treating symptomatic endometriosis.

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Condition tags

endometriosischronic_pelvic_paininfertility

MeSH descriptors

Endometriosis Gonadotropin-Releasing Hormone Hormone Replacement Therapy Adolescent Adult Endometriosis Estrogens Estrogens Female Gonadotropin-Releasing Hormone Hormone Replacement Therapy Humans Osteoporosis Osteoporosis Osteoporosis Progestins Progestins Young Adult

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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. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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