OBJECTIVE: To reach a
consensus on the role of add-back therapy for patients with endometriosis administered GnRH agonists (GnRH-a).
METHODS: Results of
consensus conference reviewing MEDLINE search of English language abstracts of both prospective and retrospective series.
METHODS: Consensus conference of 31 specialists in gynecologic surgery and reproductive endocrinology.
METHODS: Patients with symptomatic endometriosis who were candidates for GnRH-a therapy in treatment courses ranging in duration from 6 to 12 months.
METHODS: Oral steroidal and nonsteroidal add-back regimens.
METHODS: Alteration in painful symptoms, extent of disease, vasomotor symptoms, bone mineral density, and serum lipid profile.
RESULTS: When added to GnRH-a for 6 months, both 2.5 mg of norethindrone and 0.625 mg of conjugated equine estrogens with 5 mg/d of
medroxyprogesterone acetate provide effective relief of vasomotor symptoms and decrease but do not eliminate bone mineral density loss. During 12 months of GnRH-a therapy, bone mineral density loss is eliminated effectively with an add-back of 5 mg of norethindrone acetate alone or in conjunction with low-dose conjugated equine estrogens. Organic bisphosphonates also may play a role.
CONCLUSIONS: In patients with symptomatic endometriosis, the efficacy of GnRH agonists may be preserved and therapy prolonged while overcoming hypoestrogenic side effects with the use of appropriate add-back regimens.