Gnrh Agonist Combined With Hormone Add-Back Therapy In The Treatment Of Endometriosis:a Systematic Review

Objective:To compare the clinical effectiveness and safety of "Add-back" treatment for endometriosis to Gonadotropin-releasing hormone-analogue alone.Methods:We serached The Cochrane Library, MEDLINE, EMbase, VIP, WANFANG DATABASE and CNKI to March2014, articles language unlimited. Relevant journals were also hand searched. Randomized controlled trials (RCTs) of GnRH-a combined hormone add-back therapy for endometriosis were enrolled, Study selection and assessment, data collection and analysis were undertaken. Meta-analyses were performed by RevMan5.1software.Result:Eleven RCTs involving772patients were included, ten trials were compare GnRH-a+estrogen-progestin with GnRH-a+placebo/GnRH-a alone, one was compare GnRH-a+tibolone with GnRH-a+placebo. The meta-analyses showed there were significant difference between "add-back" group and combined placebo/GnRH-a alone group in lossing of bone mineral density of lumbar spine after treatment(P<0.05). The BMD of the lumbar spine after treatment is higher in "add-back" group than combined placebo/GnRH-a alone group,with a statistical significance (P<0.0001). The "add-back" group showed a higher E2level and a lower FSH level than combined placebo/GnRH-a alone group. There were no significant differences between two groups in LDL and TG, also in reducing the efficacy on endometriosis syndrome. Patients in "add-back" group had less insomnia and hot flushes than combined placebo/GnRH-a alone group.Conclution:The "add-back" treatment based on GnRH-a does not reduce its efficacy, though "add-back" treatment can mitigate the side effects of GnRH-a in osteoporosis and menopausal syndrome. Lipid-profile have not significant change during a short time.