Long-term use of gonadotropin-releasing hormone analogs and hormone replacement therapy in the management of endometriosis: a randomized trial with a 6-year follow-up

S. J. Pierce, Pierce SJ, M.Rafet Gazvani, M R Gazvani, Gazvani MR, Farquharson RG, R. G. Farquharson, Roy G. Farquharson
Fertility and sterility · 2000 · vol. 74(5) , pp. 964–968 · doi:10.1016/s0015-0282(00)01537-5 · PMID:11056241 · W2148647732
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This randomized trial with a 6-year follow-up assessed the long-term efficacy and safety of gonadotropin-releasing hormone analogs and hormone replacement therapy for endometriosis management.

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Abstract

ObjectiveTo identify the effects of long-term GnRH agonist use (6-24 months), with and without add-back therapy, and spontaneous reversibility of bone mass density (BMD) up to 6 years after treatment.DesignA prospective, randomized, long-term follow-up study.SettingObstetrics and gynecology department in a university hospital in the United Kingdom.Patient(s)Forty-nine symptomatic women with a laparoscopic diagnosis of endometriosis who had been identified for treatment with long-acting GnRH agonist and volunteered to participate in the study.Intervention(s)Women were randomly allocated to receive hormone replacement therapy (HRT) as a daily oral dose of estradiol, 2 mg, and norethisterone acetate, 1 mg, or no treatment in addition to monthly subcutaneous implants of goserelin acetate for up to 2 years, until cessation of symptoms. Bone mineral density (BMD) at the lumbar spine (C2-C4) and hip (Ward triangle) was measured every 6 months.Main outcome measure(s)BMD changes in both groups.Result(s)45 women were followed up for 6 years, at the end of which the groups did not differ significantly in the reduction in mean BMD at the lumbar spine or hip.Conclusion(s)BMD reduction occurs during long-term GnRH agonist use and is not fully recovered by up to 6 years after treatment. Use of HRT does not affect this process.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Estradiol Gonadotropin-Releasing Hormone Goserelin Hormone Replacement Therapy Hormone Replacement Therapy Norethindrone Adult Bone Density Bone Density Drug Implants Drug Therapy, Combination Endometriosis Endometriosis Estradiol Estradiol Female Follow-Up Studies Gonadotropin-Releasing Hormone Gonadotropin-Releasing Hormone

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