Obstet Gynecol Sci.  2016 Jan;59(1):32-38. 10.5468/ogs.2016.59.1.32.

Effects of different add-back regimens on hypoestrogenic problems by postoperative gonadotropin-releasing hormone agonist treatment in endometriosis

• Lee DY
• Park HG
• Yoon BK
• Choi D

• KMID: 2152641
• DOI: http://doi.org/10.5468/ogs.2016.59.1.32

Abstract

OBJECTIVE
To compare the efficacy of different add-back regimens on hypoestrogenic symptoms during postoperative gonadotropin-releasing hormone (GnRH) agonist treatment in endometriosis patients.
METHODS
This prospective cohort study included reproductive-aged women who underwent conservative laparoscopic surgery for ovarian endometriosis and received add-back therapy during a 6-month course of GnRH agonist therapy after surgery. Participants received one of four different add-back regimens: 1 mg of estradiol valerate, 2.5 mg of tibolone, or a combination of 1 mg of estradiol and 2 mg of drospirenone or 0.5 mg of norethisterone acetate. Changes in quality of life, hypoestrogenic symptoms, and bone mineral density were compared according to add-back regimens.
RESULTS
A total of 57 participants completed a 6-month course of GnRH agonist and add-back therapy. All components of quality of life did not differ across groups. However, within the same treatment group, social relationship factors decreased significantly with estradiol valerate and tibolone alone, and environmental factors decreased significantly with estradiol valerate alone. Menopausal Rating Scale score did not change significantly, but the incidence of hot flushes significantly decreased with a combination of estradiol and norethisterone acetate. Bone mineral densities at the lumbar spine declined significantly after treatment in all groups except with a combination of estradiol and norethisterone acetate.
CONCLUSION
This preliminary study suggests that an add-back regimen containing estradiol valerate and norethisterone acetate may have better efficacy in terms of quality of life, hypoestrogenism-associated symptoms, and bone mineral density.

Keyword

Add-back therapy; Endometriosis; Hypoestrogenic symptom; Quality of life

MeSH Terms

Bone Density
Cohort Studies
Endometriosis*
Estradiol
Female
Gonadotropin-Releasing Hormone*
Humans
Incidence
Laparoscopy
Norethindrone
Prospective Studies
Quality of Life
Spine
Estradiol
Gonadotropin-Releasing Hormone
Norethindrone

Figure

• 

  Fig. 1 Mean percentage changes of bone mineral densities (BMDs) at the lumbar spine and total hip in different add-back regimens after 6 cycles of gonadotropin-releasing hormone agonist. No difference was found at both sites across the four groups. Only estradiol (E2)+norethisterone acetate (NETA) group did not show a significant decrease at the lumber spine. DRSP, drospirenone. *P <0.01 vs. baseline.

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