The Place of Gonadotropin-Releasing Hormone Agonists in the Management of Endometriosis

Philippe Descamps, Andreeva En, Jinhua Leng, Shadab Salehpour, Charles Chapron
In: Journal of Endometriosis and Pelvic Pain Disorders · 2014 · vol. 6(1) , pp. 1–11 · doi:10.5301/je.5000174 · W2018424229
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This review examined the role of GnRH agonists in endometriosis management across four regions, finding they are used as second-line options for deep infiltrating endometriosis pain and to enhance IVF fertility, with potential postsurgical benefits for endometrioma recurrence.

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Abstract

Purpose This review focuses on the use of the gonadotropin-releasing hormone (GnRH) agonists, a typically marginalized class of drugs, and describes their role in the management of endometriosis, with special interest in 4 regions: Western Europe, Eastern Europe, the Middle East and China. Methods The authors met in Dubai in November 2012 for a consensus meeting on the use of GnRH agonists in the 4 regions. The meeting was based on a review of the published regional guidelines for endometriosis and a selective literature search of articles published in the past 5 years that focused on the use of GnRH agonists in endometriosis. Results The guidelines place GnRH agonists as a second-line option for the management of pain in deep infiltrating endometriosis and to improve fertility in women planning to undergo in vitro fertilization. Published articles and personal evidence presented at the meeting suggest that surgery for endometriomas should be delayed as long as possible to conserve ovarian function and that GnRH agonist therapy after surgery may reduce their recurrence. However, although add-back therapy is advocated with the use of GnRH agonists, there is no consensus on when this should be started. Conclusions There are important regional differences in cultural sensitivities to diagnosis and treatment of endometriosis, as well as a diverging approach to surgery. Given the limitations and conflicts in the diagnosis and management of endometriosis, it is essential that the available drugs, including the GnRH agonists, are used in the most appropriate settings.

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Condition tags

endometriosisdie_deep_infiltrating

Citation neighborhood (2-hop)

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. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

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