Add-back therapy in the treatment of endometriosis-associated pain.
OBJECTIVE
To determine the efficacy of GnRH analogue plus add-back therapy compared with GnRH analogue alone and estroprogestin in patients with relapse of endometriosis-associated pain.


METHODS
Randomized, controlled study.


METHODS
University hospital.


METHODS
One hundred thirty-three women with relapse of endometriosis-related pain after previous endometriosis surgery.


METHODS
Forty-six women were treated with GnRH analogue plus add-back therapy, 44 women were given GnRH analogue alone, and 43 women received estroprogestin, for 12 months.


METHODS
Pain evaluation by a visual analogue scale, quality of life in treated patients according to the SF-36 questionnaire, and occurrence of adverse effects, including bone mass density loss, at pretreatment, after 6 months of treatment, at the end of treatment (12 months), and 6 months after discontinuation of treatment.


RESULTS
Patients treated either with GnRH analogue alone or GnRH analogue plus add-back therapy showed a higher reduction of pelvic pain, dysmenorrhea, and dyspareunia than patients treated with oral contraceptive, whereas patients treated with add-back therapy showed a better quality of life, as assessed with the SF-36 questionnaire, and adverse effects rate than the other two groups.


CONCLUSIONS
Add-back therapy allows the treatment of women with relapse of endometriosis-associated pain for a longer period, with reduced bone mineral density loss, good control of pain symptoms, and better patient quality of life compared with GnRH analogue alone or oral contraceptive.
Zupi
Errico
E
Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy.
Marconi
Daniela
D
Sbracia
Marco
M
Zullo
Fulvio
F
De Vivo
Bonaventura
B
Exacustos
Caterina
C
Sorrenti
Giuseppe
G
D000328:Adult; D015519:Bone Density / Q000187:drug effects; D003276:Contraceptives, Oral / Q000009:adverse effects / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D004412:Dysmenorrhea / Q000209:etiology / Q000503:physiopathology; D004414:Dyspareunia / Q000209:etiology / Q000503:physiopathology; D004715:Endometriosis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D004997:Ethinyl Estradiol / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives*; D006801:Humans; D009652:Norpregnenes / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D010147:Pain Measurement; D010166:Palliative Care; D017699:Pelvic Pain / Q000209:etiology / Q000503:physiopathology; D011788:Quality of Life; D012008:Recurrence; D011795:Surveys and Questionnaires
D003276:Contraceptives, Oral; D004338:Drug Combinations; D009652:Norpregnenes; C494367:estroprogestin; D007987:Gonadotropin-Releasing Hormone; D004997:Ethinyl Estradiol