Clinical Valuation Observe Add-back Therapies In Patients Treated With A GnRH Agonist For Symptomatic Endometrosis

Objective:To investigate clinical valuation of GnRH agonist combined with two kinds of add-back therapy by analyzing endocrine hormone levels, low estrogen symptoms and bone loss of GnRH-a treatment for symptomatic endometriosis after laparoscopic surgery. Methods:Clinical data of eighty-two patients with endometriosis who underwent GnRH-a treatment after laparoscopic surgery from 2009 to 2010 were retrospectively analyzed. According to the way of receiving add-back therapy, two groups were randomly divided and the clinical data were compared. Group A of 37 patients was used in combination with estradiol vale rate (Progynova) 0.5 mg(group Ai) or lmg(group A2), and medroxyprogesterone 4 mg per day, group B of 38 patients used tibolone 1.25mg (group B1) or 2.5mg(group B2)and medroxyprogesterone 4 mg per day. After treatment, clinical parameters were recorded and analyzed, including visual analog scale (VAS), Kupperman index, the serum level of follicle stimulating hormone (FSH), estradiol (E2) and bone gla-protein (BGP). The first menstruation and VAS were also recorded and analyzed after treatment. Results:After received add-back therapy, the serum level of endocrine hormones such as follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2) were decreased statistically after treatment in both group (P<0.01). When endocrine hormone of different dose of add-back therapy were compared before and after the treatment, the level of estradiol (E2) in group A1 was lower than that in group A2, the levels of FSH in group A1 was higher than that in group A2; neither level of E2 or level of FSH were found different in group B1 or group B2 statistically (P>0.05). Before and after the treatment, level of BGP was statistical difference in both group (P<0.05). Visual analogue scale, kupperman score and serum osteocalcin level were significantly decreased between pre-therapy and post-therapy in both groups (P<0.01). Conclusions:GnRH-a combined with estradiol vale rate (Progynova) could reduce hypo-estrogenic symptoms, bone loss and relieve pain of endometriosis as effectively as GnRH-a combined with tibolone. Therefore, it is a safe and effective treatment which can also improve compliance of patients.