title: Gonadotropin-releasing hormone agonist plus estrogen-progestin "add-back" therapy for endometriosis-related pelvic pain.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of leuprolide acetate depot (LA, Lupron; TAP Pharmaceuticals, Deerfield, IL) plus daily conjugated equine estrogens (Es, Premarin; Wyeth-Ayerst Laboratories, Philadelphia, PA), and medroxyprogesterone acetate (MPA, Provera; The Upjohn Company, Kalamazoo, MI) "add-back" treatment of endometriosis-associated pelvic pain.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Tertiary care, academic medical center.
  
  
  METHODS
  Eight patients with moderate to severe pelvic pain and laparoscopically documented endometriosis.
  
  
  METHODS
  Leuprolide acetate depot 3.75 mg IM every 4 weeks for 24 months. Oral conjugated equine Es 0.625 mg/d plus MPA 2.5 mg/d were also taken from treatment months 3 through 24.
  
  
  RESULTS
  Six women completed the 2-year study. Mean revised endometriosis scores for implants, adhesions, and total values were significantly reduced at the conclusion of treatment from pretreatment scores. Self-reported pelvic pain scores were significantly lower at treatment months 3, 6, 12, 18, 24, and 6 months after therapy than pretreatment scores. Dual X-ray absorptiometry bone density measurements of the lumbar spine did not change significantly during the 24-month treatment period. The proportion of women experiencing hot flushes was significantly reduced after E-progestin add-back treatment from the proportion at treatment month 3.
  
  
  CONCLUSIONS
  Treatment with LA depot plus conjugated equine Es and MPA for 2 years was a safe and effective therapy for women with endometriosis and pelvic pain in this small retrospective study.
authors.affiliation: Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115.
authors.forename: A J
authors.initials: AJ
authors.lastname: Friedman
authors.forename: M D
authors.initials: MD
authors.lastname: Hornstein
mesh_terms: D000328:Adult; D015519:Bone Density / Q000187:drug effects; D004343:Drug Implants; D004715:Endometriosis / Q000503:physiopathology*; D004967:Estrogens / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016729:Leuprolide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008598:Menstruation / Q000187:drug effects; D010146:Pain / Q000188:drug therapy* / Q000503:physiopathology; D010388:Pelvis; D011372:Progestins / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D004343:Drug Implants; D004967:Estrogens; D011372:Progestins; D016729:Leuprolide