Effects of different add-back regimens on hypoestrogenic problems by postoperative gonadotropin-releasing hormone agonist treatment in endometriosis
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
ObjectiveTo compare the efficacy of different add-back regimens on hypoestrogenic symptoms during postoperative gonadotropin-releasing hormone (GnRH) agonist treatment in endometriosis patients. MethodsThis prospective cohort study included reproductive-aged women who underwent conservative laparoscopic surgery for ovarian endometriosis and received add-back therapy during a 6-month course of GnRH agonist therapy after surgery. Participants received one of four different add-back regimens: 1 mg of estradiol valerate, 2.5 mg of tibolone, or a combination of 1 mg of estradiol and 2 mg of drospirenone or 0.5 mg of norethisterone acetate. Changes in quality of life, hypoestrogenic symptoms, and bone mineral density were compared according to add-back regimens. ResultsA total of 57 participants completed a 6-month course of GnRH agonist and add-back therapy. All components of quality of life did not differ across groups. However, within the same treatment group, social relationship factors decreased significantly with estradiol valerate and tibolone alone, and environmental factors decreased significantly with estradiol valerate alone. Menopausal Rating Scale score did not change significantly, but the incidence of hot flushes significantly decreased with a combination of estradiol and norethisterone acetate. Bone mineral densities at the lumbar spine declined significantly after treatment in all groups except with a combination of estradiol and norethisterone acetate. ConclusionThis preliminary study suggests that an add-back regimen containing estradiol valerate and norethisterone acetate may have better efficacy in terms of quality of life, hypoestrogenism-associated symptoms, and bone mineral density.
Abstract
ObjectiveTo compare the efficacy of different add-back regimens on hypoestrogenic symptoms during postoperative gonadotropin-releasing hormone (GnRH) agonist treatment in endometriosis patients. MethodsThis prospective cohort study included reproductive-aged women who underwent conservative laparoscopic surgery for ovarian endometriosis and received add-back therapy during a 6-month course of GnRH agonist therapy after surgery. Participants received one of four different add-back regimens: 1 mg of estradiol valerate, 2.5 mg of tibolone, or a combination of 1 mg of estradiol and 2 mg of drospirenone or 0.5 mg of norethisterone acetate. Changes in quality of life, hypoestrogenic symptoms, and bone mineral density were compared according to add-back regimens. ResultsA total of 57 participants completed a 6-month course of GnRH agonist and add-back therapy. All components of quality of life did not differ across groups. However, within the same treatment group, social relationship factors decreased significantly with estradiol valerate and tibolone alone, and environmental factors decreased significantly with estradiol valerate alone. Menopausal Rating Scale score did not change significantly, but the incidence of hot flushes significantly decreased with a combination of estradiol and norethisterone acetate. Bone mineral densities at the lumbar spine declined significantly after treatment in all groups except with a combination of estradiol and norethisterone acetate. ConclusionThis preliminary study suggests that an add-back regimen containing estradiol valerate and norethisterone acetate may have better efficacy in terms of quality of life, hypoestrogenism-associated symptoms, and bone mineral density.
참고문헌 (25)
- Giudice LC, "Clinical practice : endometriosis", N Engl J Med, 362, pp.2389~2398 (2010)
- Dlugi AM, "Lupron depot (leuprolide acetate for depot suspension) in the treatment of endometriosis:a randomized, placebo-controlled, double-blind study. Lupron Study Group", Fertil Steril, 54, pp.419~427 (1990)
- Steingold KA, "Treatment of endometriosis with a long-acting gonadotropin-releasing hormone agonist", Obstet Gynecol, 69(3 Pt 1), pp.403~411 (1987)
- Al Kadri H, "Hormone therapy for endometriosis and surgical menopause", Cochrane Database Syst Rev (2009)
- ACOG Committee on Practice Bulletins: Gynecology, "ACOG practice bulletin. Medical management of endometriosis. Number 11, December 1999 (replaces Technical Bulletin Number 184, September 1993). Clinical management guidelines for obstetrician-gynecologists", Int J Gynaecol Obstet, 71, pp.183~196 (2000)
- Simoens S, "The burden of endometriosis : costs and quality of life of women with endometriosis and treated in referral centres", Hum Reprod, 27, pp.1292~1299 (2012)
- Nnoaham KE, "Impact of endometriosis on quality of life and work productivity:a multicenter study across ten countries", Fertil Steril, 96, pp.366~373 (2011)
- Fourquet J, "Quantification of the impact of endometriosis symptoms on health-related quality of life and work productivity", Fertil Steril, 96, pp.107~112 (2011)
- Warnock JK, "Anxiety and mood disorders associated with gonadotropin-releasing hormone agonist therapy", Psychopharmacol Bull, 33, pp.311~316 (1997)
- Bergqvist A, "Changes in quality of life after hormonal treatment of endometriosis", Acta Obstet Gynecol Scand, 80, pp.628~637 (2001)
- Kiilholma P, "Comparison of the gonadotropin-releasing hormone agonist goserelin acetate alone versus goserelin combined with estrogen-progestogen add-back therapy in the treatment of endometriosis", Fertil Steril, 64, pp.903~908 (1995)
- Riis BJ, "Is it possible to prevent bone loss in young women treated with luteinizing hormone-releasing hormone agonists?", J Clin Endocrinol Metab, 70, pp.920~924 (1990)
- Taskin O, "Effectiveness of tibolone on hypoestrogenic symptoms induced by goserelin treatment in patients with endometriosis", Fertil Steril, 67, pp.40~45 (1997)
- Heinemann LA, "International versions of the Menopause Rating Scale (MRS)", Health Qual Life Outcomes, 1, pp.28~ (2003)
- Fourquet J, "Patients’ report on how endometriosis affects health, work, and daily life", Fertil Steril, 93, pp.2424~2428 (2010)
- Bethea CL, "Ovarian steroids and serotonin neural function", Mol Neurobiol, 18, pp.87~123 (1998)
- Epperson CN, "Gonadal steroids in the treatment of mood disorders", Psychosom Med, 61, pp.676~697 (1999)
- Bhattacharya SM, "Health-related quality of life following surgical menopause and following gonadotrophinreleasing hormone analogue-induced pseudomenopause", Gynecol Endocrinol, 25, pp.621~623 (2009)
- Roux C, "Bone loss during gonadotropin releasing hormone agonist treatment and use of nasal calcitonin", Osteoporos Int, 5, pp.185~190 (1995)
- Moghissi KS, "Goserelin acetate(Zoladex)with or without hormone replacement therapy for the treatment of endometriosis", Fertil Steril, 69, pp.1056~1062 (1998)
- Franke HR, "Gonadotropin-releasing hormone agonist plus “add-back” hormone replacement therapy for treatment of endometriosis: a prospective, randomized, placebo-controlled, double-blind trial", Fertil Steril, 74, pp.534~539 (2000)
- Fernandez H, "One year comparison between two add-back therapies in patients treated with a GnRH agonist for symptomatic endometriosis : a randomized double-blind trial", Hum Reprod, 19, pp.1465~1471 (2004)
- Lindsay PC, "The effect of add-back treatment with tibolone(Livial)on patients treated with the gonadotropin-releasing hormone agonist triptorelin(Decapeptyl)", Fertil Steril, 65, pp.342~348 (1996)
- Leather AT, "The prevention of bone loss in young women treated with GnRH analogues with"add-back"estrogen therapy", Obstet Gynecol, 81, pp.104~107 (1993)
- Onobrakpeya OA, "Effect of norethindrone acetate on hormone levels and markers of bone turnover in estrogen-treated postmenopausal women", Endocr Res, 27, pp.473~480 (2001)