Long-term use of gonadotropin-releasing hormone analogs and hormone replacement therapy in the management of endometriosis: a randomized trial with a 6-year follow-up.
OBJECTIVE
To identify the effects of long-term GnRH agonist use (6-24 months), with and without add-back therapy, and spontaneous reversibility of bone mass density (BMD) up to 6 years after treatment.


METHODS
A prospective, randomized, long-term follow-up study.


METHODS
Obstetrics and gynecology department in a university hospital in the United Kingdom.


METHODS
Forty-nine symptomatic women with a laparoscopic diagnosis of endometriosis who had been identified for treatment with long-acting GnRH agonist and volunteered to participate in the study.


METHODS
Women were randomly allocated to receive hormone replacement therapy (HRT) as a daily oral dose of estradiol, 2 mg, and norethisterone acetate, 1 mg, or no treatment in addition to monthly subcutaneous implants of goserelin acetate for up to 2 years, until cessation of symptoms. Bone mineral density (BMD) at the lumbar spine (C2-C4) and hip (Ward triangle) was measured every 6 months.


METHODS
BMD changes in both groups.


RESULTS
45 women were followed up for 6 years, at the end of which the groups did not differ significantly in the reduction in mean BMD at the lumbar spine or hip.


CONCLUSIONS
BMD reduction occurs during long-term GnRH agonist use and is not fully recovered by up to 6 years after treatment. Use of HRT does not affect this process.
Pierce
S J
SJ
Department of Obstetrics and Gynecology, Liverpool Women's Hospital, Liverpool, United Kingdom.
Gazvani
M R
MR
Farquharson
R G
RG
D000328:Adult; D015519:Bone Density / Q000187:drug effects; D004343:Drug Implants; D004359:Drug Therapy, Combination; D004715:Endometriosis / Q000188:drug therapy* / Q000378:metabolism; D004958:Estradiol / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists / Q000031:analogs & derivatives*; D017273:Goserelin / Q000009:adverse effects / Q000627:therapeutic use*; D006621:Hip Joint / Q000378:metabolism; D020249:Hormone Replacement Therapy / Q000009:adverse effects; D006801:Humans; D008137:Longitudinal Studies; D008161:Lumbosacral Region; D008875:Middle Aged; D009640:Norethindrone / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use*; D000077563:Norethindrone Acetate; D011446:Prospective Studies; D013131:Spine / Q000378:metabolism
D004343:Drug Implants; D017273:Goserelin; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol; D000077563:Norethindrone Acetate; D009640:Norethindrone