title: Complete remission of OC-resistant catamenial shoulder joint pain and inguinal pain associated with extraperitoneal endometriosis following personalized GnRH agonist therapy.
abstract: BACKGROUND
  Patients with severe extraperitoneal endometriosis require rapid remission and cannot wait for the effects of oral contraceptive hormones (OCs) to appear.
  
  
  METHODS
  We successfully achieved personalized gonadotropin-releasing hormone agonist (GnRHa) therapy for a patient with catamenial right shoulder joint pain and right inguinal pain associated with extraperitoneal endometriosis, which was completely unable to be suppressed by OCs. A total of 15 subcutaneous GnRHa depot injections over a period of 19 months was performed according to the serum estradiol and LH levels, in order to maintain long-term amenorrhea without any estrogen-deprivation effects. No recurrence of the catamenial symptoms has been observed for more than 35 months after the final GnRHa depot injection.
  
  
  CONCLUSIONS
  Personalized GnRHa therapy should become the first-choice therapy for OC-resistant inoperable extraperitoneal endometriosis.
authors.affiliation: Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama, Japan. tetanaka@wakayama-med.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Tanaka
authors.forename: N
authors.initials: N
authors.lastname: Umesaki
mesh_terms: D004715:Endometriosis / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D007264:Inguinal Canal / Q000473:pathology; D007279:Injections, Subcutaneous; D016729:Leuprolide / Q000008:administration & dosage*; D008875:Middle Aged; D020069:Shoulder Pain / Q000188:drug therapy / Q000209:etiology
chemical_list: D005300:Fertility Agents, Female; D007987:Gonadotropin-Releasing Hormone; D016729:Leuprolide