Abstract：
Gonadotrophin-releasing hormone (GnRH) antagonists have been demonstrated to reduce endometriosis-associated pain. Because of the hypo-oestrogenic state they induce, however, higher dosages of GnRH antagonists are not recommended for used long term. This unwanted effect may be eliminated by so-called add-back therapy (ABT). This review was conducted to assess the safety and efficacy of GnRH antagonists, with or without add-back hormonal replacement therapy. Out of the 345 studies selected through the initial search, seven randomized controlled trials were included, comparing different oral GnRH antagonists at varying dosages, from a minimum of 50 mg to a maximum of 200 mg once or twice daily. Women treated with the lowest dose of GnRH antagonists had significantly greater mean pain score reductions from baseline throughout treatment compared with those treated with placebo (odds ratio [OR] -13.12, 95% CI -17.35 to -8.89 and OR -3.08, 95% CI -4.39 to -1.76 for dysmenorrhoea and non-menstrual pelvic pain, respectively). Compatible with the dose-response effect, a positive correlation was found between response rates and adverse event rates. While GnRH antagonists offer an advantage in terms of pain reduction for endometriosis, the more recent literature suggests using GnRH antagonists with ABT, which, while mitigating the hypo-oestrogenic effects of GnRH antagonists, maintain their efficacy, while allowing their long-term use.
摘要：
促性腺激素释放激素（GnRH）拮抗剂已被证明可以减轻子宫内膜异位症相关的疼痛。由于它们诱导的低雌激素状态，然而,不建议长期使用更高剂量的GnRH拮抗剂.这种不希望的效应可以通过所谓的回加疗法(ABT)来消除。本综述旨在评估GnRH拮抗剂的安全性和有效性。有或没有补充激素替代疗法。在通过初始搜索选择的345项研究中，包括7项随机对照试验，比较不同剂量的不同口服GnRH拮抗剂，从最低50毫克到最高200毫克，每天一次或两次。与接受安慰剂治疗的女性相比，接受最低剂量GnRH拮抗剂治疗的女性在整个治疗期间的平均疼痛评分从基线降低显著(痛经和非经期盆腔疼痛的比值比[OR]-13.12,95%CI-17.35至-8.89和OR-3.08,95%CI-4.39至-1.76,分别)。与剂量反应效应相容，应答率和不良事件发生率呈正相关.虽然GnRH拮抗剂在减轻子宫内膜异位症的疼痛方面具有优势，最近的文献表明使用GnRH拮抗剂与ABT，which,在减轻GnRH拮抗剂的低雌激素作用的同时，保持其功效，同时允许其长期使用。
