An alternative to hysterectomy? GnRH analogue combined with hormone replacement therapy.
OBJECTIVE
To assess whether GnRH analogues are effective in relieving pelvic pain and congestion and whether menopausal symptoms caused by GnRH analogues can be minimised by supplementation with low dose continuous combined hormone replacement therapy (HRT).


METHODS
Open prospective study.


METHODS
Tertiary referral clinic at a teaching hospital.


METHODS
Twenty-one women with chronic pelvic pain.


METHODS
Four months' therapy with goserelin 3.6 mg/month combined with continuous oestradiol valerate 1 mg daily and medroxyprogesterone acetate 5 mg daily.


METHODS
Visual analogue scale for pain, menopausal symptoms, bleeding patterns, uterine area, endometrial status, oestradiol concentrations and venogram scores.


RESULTS
Amenorrhoea was maintained in all but two women. Endometrial atrophy was maintained despite HRT supplementation. Two women had moderate menopausal symptoms but none had severe symptoms. Significant reduction of uterine cross sectional area was maintained throughout the study. There was no significant relief of pain.


CONCLUSIONS
HRT supplementation of GnRH analogues abolishes menopausal symptoms and thus may improve patient acceptability. Potentially beneficial effects such as endometrial atrophy, reduction of uterine volume and amenorrhoea were not negated by HRT. This combination is not effective in the treatment of chronic pelvic pain and congestion.
Department of Obstetrics and Gynaecology, St Mary's Hospital Medical School, London, UK.
K F
KF
Gangar
R W
RW
Stones
D
D
Saunders
V
V
Rogers
T
T
Rae
S
S
Cooper
R W
RW
Beard
D000328:Adult; D002908:Chronic Disease; D004958:Estradiol / Q000031:analogs & derivatives* / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy; D005260:Female; D017273:Goserelin / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007044:Hysterectomy; D017258:Medroxyprogesterone Acetate / Q000627:therapeutic use*; D008593:Menopause / Q000187:drug effects; D010147:Pain Measurement; D017060:Patient Satisfaction; D000292:Pelvic Inflammatory Disease / Q000188:drug therapy*; D011446:Prospective Studies; D013997:Time Factors
D017273:Goserelin; D004958:Estradiol; D017258:Medroxyprogesterone Acetate