Clinical and Experimental Obstetrics & Gynecology (Oct 2023)

Add-Back and Combined Regulation in GnRH-a Treatment of Endometriosis

  • Huimin Tang,
  • Qiucheng Jia,
  • Zhiyong Dong,
  • Yao Chen,
  • Wulin Shan,
  • Yihan Wu,
  • Miao Miao,
  • Tingwei Xing,
  • Weiwei Wei,
  • Bin Tang,
  • Hong Zheng,
  • Ruxia Shi,
  • Bairong Xia,
  • Jiming Chen

DOI
https://doi.org/10.31083/j.ceog5010224
Journal volume & issue
Vol. 50, no. 10
p. 224

Abstract

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Objective: The purpose of this review is to summarize drug selection for peri-menopausal symptoms caused by gonadotropin releasing-hormone agonist (GnRH-a) in the treatment of endometriosis. Mechanism: GnRH-a treatment often leads to low estrogen levels, resulting in peri-menopausal symptoms and osteoporosis. Add-back therapy relieves clinical symptoms by supplementing low-dose estrogen. The idea of “combined regulation” is to improve symptoms by adding plant preparations or proprietary Chinese medicines. Studies have shown that they may play a role by regulating serotonin activity. Findings in Brief: For patients treated with GnRH-a for less than 3 months, the combined-regulation regimen can be considered, whereas for patients who have had more than 3 courses of GnRH-a, add-back therapy with sex hormones must be used because the patients will have begun to have obvious bone-mass loss and even bone pain; this bone-mass loss is often irreversible. Conclusions: In the early treatment of endometriosis with GnRH-a, non-hormone combined-regulation therapy is a relatively safe and feasible choice, but hormone add-back therapy should be selected for patients who have had more than 3 courses of GnRH-a.

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