Add-back therapy in the treatment of endometriosis: the European experience.
Add-back hormone replacement therapy (HRT) can alleviate the undesirable hypo-oestrogenic effects of the gonadotrophin-releasing hormone (GnRH) agonists, including loss in bone mineral content. However, this approach presents a dilemma in patients with endometriosis as the re-introduction of oestrogen could re-stimulate the endometriotic process. There have been three recently published European studies investigating the combination of GnRH agonist plus add-back HRT in the treatment of endometriosis. The loss of bone mineral density was significantly diminished in a study using 25 micrograms oestradiol patches combined with continuous medroxyprogesterone acetate (5 mg). Neither this low oestrogen dose nor a full bone-sparing dose of oral oestradiol (2 mg daily) reduced the efficacy of Zoladex (goserelin acetate) in patients with endometriosis. Furthermore, in a small open study the gonadomimetic tibolone totally prevented the loss of bone structure during GnRH agonist therapy. If a GnRH agonist is considered the treatment of choice, then HRT should be used in combination.
Department of Obstetrics and Gynaecology, Queen Charlotte's & Chelsea Hospital, London, UK.
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Edmonds
D000279:Administration, Cutaneous; D015519:Bone Density; D004311:Double-Blind Method; D004338:Drug Combinations; D004715:Endometriosis / Q000188:drug therapy*; D004958:Estradiol / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*; D015914:Estrogen Replacement Therapy / Q000379:methods*; D005260:Female; D017273:Goserelin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D007986:Luteinizing Hormone / Q000097:blood; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage / Q000627:therapeutic use*; D009640:Norethindrone / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000077563:Norethindrone Acetate; D016896:Treatment Outcome
D004338:Drug Combinations; D017273:Goserelin; D004958:Estradiol; D007986:Luteinizing Hormone; D000077563:Norethindrone Acetate; D017258:Medroxyprogesterone Acetate; D009640:Norethindrone