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[Clinical efficacy and safety of gonadotropin releasing hormone agonist combined with estrogen-dydrogesteronea in treatment of endometriosis].

AbstractOBJECTIVE:
To compare clinical effect of gonadotropin releasing hormone agonist (GnRH-a) alone and GnRH-a combined with low-dose dydrogesteronea and estradiol valerate on sex hormone, hypoestrogenic symptoms, quality of life and bone mineral density (BMD) in treatment of endometriosis.
METHODS:
Seventy patients with moderate or severe endometriosis, who were diagnosed by laparotomy or laparoscopic surgery within two months, were randomly assigned into two groups. 35 patients in GnRH-a group were treated by goserelin (3.6 mg) for three months, and 35 patients in add-back group were treated by goserelin (3.6 mg) combined with estradiol valerate 0.5 mg and dydrogesteronea 5 mg daily. Before and after the treatment, clinical parameters were recorded and analyzed, including visual analog scale (VAS), medical outcomes survey short form 36 (SF-36), Kupperman menopausal index (KMI), BMD, the serum level of follicle stimulating hormone (FSH), estradiol (E2) and bone gla-protein (BGP). The first menstruation and VAS were also followed up after treatment.
RESULTS:
Every 3 cases in two groups lost follow-up. (1) Reproductive hormone: the level of E2 in add-back group [(94+/-71) pmol/L] was significantly higher than (54+/-52) pmol/L in GnRH-a group (P<0.01). The level of FSH in add-back group [(3.0+/-1.9) U/L] was significantly lower than (5.7+/-2.9) U/L in GnRH-a group (P<0.05). (2) VAS: after treatment, VAS in both group decreased significantly when compared with that before treatment (P<0.05), and remained until menstruated. (3) KMI: KMI in add back-group (10+/-8)was significantly lower than (14+/-6) in GnRH-a group (P<0.05). (4) BMD: compared with that before treatment, BMD decreased significantly after treatment in GnRH-a group (P<0.05), no remarkable difference of BMD was observed before and after treatment in add-back group. Before treatment, serum BGP in both groups did not show statistical difference. After treatment, the level of BGP in GnRH-a group [(7932+/-5206) ng/L] was significantly higher than (5419+/-2917) ng/L in add-back group (P<0.05).
CONCLUSIONS:
GnRH-a combined with estrogen-progesterone regimen could relieve pain from endometriosis as effectively as GnRH-a alone and reduce hypoestrogenic symptoms and bone loss. Therefore, it is a safe and effective treatment.
AuthorsQi-qi Long, Shao-fen Zhang, Yi Han, Hang Chen, Xue-lian Li, Ke-qin Hua, Wei-guo Hu
JournalZhonghua fu chan ke za zhi (Zhonghua Fu Chan Ke Za Zhi) Vol. 45 Issue 4 Pg. 247-51 (Apr 2010) ISSN: 0529-567X [Print] China
PMID20646533 (Publication Type: English Abstract, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
Chemical References
  • Goserelin
  • Osteocalcin
  • Gonadotropin-Releasing Hormone
  • Estradiol
  • Follicle Stimulating Hormone
  • Dydrogesterone
  • estradiol valerate
Topics
  • Adolescent
  • Adult
  • Bone Density (drug effects)
  • Drug Administration Schedule
  • Dydrogesterone (administration & dosage, therapeutic use)
  • Endometriosis (blood, drug therapy, pathology)
  • Estradiol (administration & dosage, analogs & derivatives, blood, therapeutic use)
  • Female
  • Follicle Stimulating Hormone (blood)
  • Gonadotropin-Releasing Hormone (administration & dosage, agonists)
  • Goserelin (pharmacology, therapeutic use)
  • Humans
  • Middle Aged
  • Osteocalcin (blood)
  • Pain (drug therapy, pathology)
  • Quality of Life
  • Severity of Illness Index
  • Treatment Outcome
  • Young Adult

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