Minimising menopausal side effects whilst treating endometriosis and fibroids

Paul D Simpson, Paul Simpson, McLaren JS, James S. McLaren, Rymer J, Janice Rymer, Morris EP, Edward P. Morris, Edward Morris
Post reproductive health · 2015 · vol. 21(1) , pp. 16–23 · doi:10.1177/2053369114568440 · PMID:25802141 · W1973084262
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-07 ⓘ

Gonadotrophin-releasing hormone agonists treat endometriosis and fibroids by altering sex hormones but cause menopausal side effects, which can be mitigated with hormone replacement therapy.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 · read from full text ⓘ

The paper reviews how medical treatment for endometriosis and uterine fibroids manipulates the hypothalamic-pituitary-gonadal axis, including the use of gonadotrophin-releasing hormone agonists that can cause short-term hypoestrogenic and vasomotor side effects and longer-term concerns such as bone health and cardiovascular risk. It reports that routine add-back hormone replacement has reduced these risks and improved tolerability and treatment duration, framing this as a “therapeutic window” under the estrogen threshold hypothesis where bone loss is minimized without aggravating the disease. A stated limitation is that the discussion is conceptual/overview-based rather than presenting new trial results, and it emphasizes background rationale for emerging approaches. This paper is centrally about endometriosis — it focuses on minimizing menopausal side effects during hormonal treatment of endometriosis (and fibroids) and explains the rationale for add-back therapy and newer hormone-modulating strategies.

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Abstract

Medical management of endometriosis and fibroids involves manipulation of the hypothalamic-pituitary-gonadal axis to alter the balance of sex hormones thereby inhibiting disease progression and ameliorate symptoms. Unfortunately, resultant menopausal symptoms sometimes limit the tolerability and duration of such treatment. The use of gonadotrophin-releasing hormone agonists to treat these diseases can result in short-term hypoestrogenic and vasomotor side effects as well as long-term impacts on bone health and cardiovascular risk. The routine use of add-back hormone replacement has reduced these risks and increased patient compliance, making this group of drugs more useful as a medium-term treatment option. The estrogen threshold hypothesis highlights the concept of a 'therapeutic window' in which bone loss is minimal but the primary disease is not aggravated. It explains why add-back therapy is appropriate for such patients and helps to explain the basis behind new developments in the treatment of hormonally responsive gynaecological conditions such as gonadotrophin-releasing hormone antagonists and progesterone receptor modulators.
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Abstract

Medical management of endometriosis and fibroids involves manipulation of the hypothalamic-pituitary-gonadal axis to alter the balance of sex hormones thereby inhibiting disease progression and ameliorate symptoms. Unfortunately, resultant menopausal symptoms sometimes limit the tolerability and duration of such treatment. The use of gonadotrophin-releasing hormone agonists to treat these diseases can result in short-term hypoestrogenic and vasomotor side effects as well as long-term impacts on bone health and cardiovascular risk. The routine use of add-back hormone replacement has reduced these risks and increased patient compliance, making this group of drugs more useful as a medium-term treatment option. The estrogen threshold hypothesis highlights the concept of a 'therapeutic window' in which bone loss is minimal but the primary disease is not aggravated. It explains why add-back therapy is appropriate for such patients and helps to explain the basis behind new developments in the treatment of hormonally responsive gynaecological conditions such as gonadotrophin-releasing hormone antagonists and progesterone receptor modulators. | Original language | English | |---|---| | Pages (from-to) | 16-23 | | Number of pages | 8 | | Journal | Post reproductive health | | Volume | 21 | | Issue number | 1 | | DOIs | | | Publication status | Published - 1 Mar 2015 |

Keywords

- Add-back - endometriosis - fibroids - GnRHantagonists - SPRMs Fingerprint Dive into the research topics of 'Minimising menopausal side effects whilst treating endometriosis and fibroids'. Together they form a unique fingerprint.Cite this - APA - Author - BIBTEX - Harvard - Standard - RIS - Vancouver

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Gonadotropin-Releasing Hormone Hormone Replacement Therapy Leiomyoma Uterine Neoplasms Antineoplastic Agents, Hormonal Antineoplastic Agents, Hormonal Antineoplastic Agents, Hormonal Bone Density Bone Density Contraceptives, Oral, Combined Contraceptives, Oral, Combined Contraceptives, Oral, Combined Delayed-Action Preparations Delayed-Action Preparations Endometriosis Endometriosis Estrogens Estrogens Estrogens

Citation neighborhood

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.

References (51)

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