Immediate and delayed add-back hormonal replacement therapy during ultra long GnRH agonist treatment of chronic cyclical pelvic pain.

Abstract

OBJECTIVE:

To assess the safety and efficacy of long-term use of long-acting GnRH agonist in women with chronic cyclical pelvic pain using immediate versus delayed add-back hormonal replacement therapy (HRT).

DESIGN:

A prospective randomised trial.

SETTING:

Reproductive and Developmental Medicine, Academic Unit, University Teaching Hospital and NHS Hospitals.

POPULATION:

Thirty-eight premenopausal women with chronic cyclical pelvic pain were recruited.

METHODS:

Women were given Zoladex 10.8 mg over 18 months and randomised to receive HRT (tibolone 2.5 mg) either immediately or after 6 months. Follow up was 12-month post-treatment.

MAIN OUTCOME MEASURES:

Bone mineral density at 6 months, the end of treatment (18 months), and 12 months later, pain and quality of life.

RESULTS:

Women treated with immediate HRT add-back showed less bone mineral density loss at 6 months and less vasomotor symptoms compared with those who had delayed HRT add-back treatment. Long-term follow up showed both groups experienced equivalent bone mineral density loss. Pain and health-related quality-of-life assessment showed improvement in both groups but there was evidence of a return to baseline levels after ending treatment.

CONCLUSION:

Long-term use of GnRH agonist plus immediate add-back HRT is a safe and acceptable approach to intractable cyclical pelvic pain. Given the delay in reactivation of the hypothalamo-pituitary-ovarian axis after long-term suppression, an intermittent dose regime with GnRH agonist might warrant investigation.

• Authors: M Al-Azemi, G Jones, F Sirkeci, S Walters, M Houdmont, W Ledger
• Journal: BJOG : an international journal of obstetrics and gynaecology (BJOG) Vol. 116 Issue 12 Pg. 1646-56 (Nov 2009) ISSN: 1471-0528 [Electronic] England
• PMID: 19735378 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Norpregnenes
• Goserelin
• Gonadotropin-Releasing Hormone
• tibolone

Topics

• Adult
• Bone Density (drug effects)
• Chronic Disease
• Drug Administration Schedule
• Drug Therapy, Combination
• Estrogen Replacement Therapy (methods)
• Female
• Follow-Up Studies
• Gonadotropin-Releasing Hormone (agonists)
• Goserelin (administration & dosage)
• Humans
• Middle Aged
• Norpregnenes (administration & dosage)
• Pain Measurement (methods)
• Pelvic Pain (drug therapy)
• Premenopause
• Quality of Life
• Treatment Outcome
• Young Adult