[Clinical efficacy and safety of gonadotropin releasing hormone agonist combined with estrogen-dydrogesteronea in treatment of endometriosis].
OBJECTIVE
To compare clinical effect of gonadotropin releasing hormone agonist (GnRH-a) alone and GnRH-a combined with low-dose dydrogesteronea and estradiol valerate on sex hormone, hypoestrogenic symptoms, quality of life and bone mineral density (BMD) in treatment of endometriosis.


METHODS
Seventy patients with moderate or severe endometriosis, who were diagnosed by laparotomy or laparoscopic surgery within two months, were randomly assigned into two groups. 35 patients in GnRH-a group were treated by goserelin (3.6 mg) for three months, and 35 patients in add-back group were treated by goserelin (3.6 mg) combined with estradiol valerate 0.5 mg and dydrogesteronea 5 mg daily. Before and after the treatment, clinical parameters were recorded and analyzed, including visual analog scale (VAS), medical outcomes survey short form 36 (SF-36), Kupperman menopausal index (KMI), BMD, the serum level of follicle stimulating hormone (FSH), estradiol (E2) and bone gla-protein (BGP). The first menstruation and VAS were also followed up after treatment.


RESULTS
Every 3 cases in two groups lost follow-up. (1) Reproductive hormone: the level of E2 in add-back group [(94+/-71) pmol/L] was significantly higher than (54+/-52) pmol/L in GnRH-a group (P<0.01). The level of FSH in add-back group [(3.0+/-1.9) U/L] was significantly lower than (5.7+/-2.9) U/L in GnRH-a group (P<0.05). (2) VAS: after treatment, VAS in both group decreased significantly when compared with that before treatment (P<0.05), and remained until menstruated. (3) KMI: KMI in add back-group (10+/-8)was significantly lower than (14+/-6) in GnRH-a group (P<0.05). (4) BMD: compared with that before treatment, BMD decreased significantly after treatment in GnRH-a group (P<0.05), no remarkable difference of BMD was observed before and after treatment in add-back group. Before treatment, serum BGP in both groups did not show statistical difference. After treatment, the level of BGP in GnRH-a group [(7932+/-5206) ng/L] was significantly higher than (5419+/-2917) ng/L in add-back group (P<0.05).


CONCLUSIONS
GnRH-a combined with estrogen-progesterone regimen could relieve pain from endometriosis as effectively as GnRH-a alone and reduce hypoestrogenic symptoms and bone loss. Therefore, it is a safe and effective treatment.
Long
Qi-qi
QQ
Department of Gynecology, Obstetris and Gynecology Hospital, Fudan University, Shanghai 200011, China.
Zhang
Shao-fen
SF
Han
Yi
Y
Chen
Hang
H
Li
Xue-lian
XL
Hua
Ke-qin
KQ
Hu
Wei-guo
WG
D000293:Adolescent; D000328:Adult; D015519:Bone Density / Q000187:drug effects; D004334:Drug Administration Schedule; D004394:Dydrogesterone / Q000008:administration & dosage* / Q000627:therapeutic use; D004715:Endometriosis / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D004958:Estradiol / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000097:blood / Q000627:therapeutic use; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000819:agonists*; D017273:Goserelin / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood; D010146:Pain / Q000188:drug therapy / Q000473:pathology; D011788:Quality of Life; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
D017273:Goserelin; D015675:Osteocalcin; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol; D005640:Follicle Stimulating Hormone; D004394:Dydrogesterone