The gonadotrophin-releasing
hormone (
GnRH) agonists are an efficacious medical approach for the management of both
dysfunctional uterine bleeding (DUB) and
uterine fibroids. However, due to the long-term effects of
GnRH agonists on bone mass, their use is restricted to short courses. Add-back
hormone replacement therapy (HRT) is one strategy that could minimise the hypo-oestrogenic effects of
GnRH agonists, without nullifying their
therapeutic effects. In one study of add-back
therapy with cyclical
oestradiol/norgestrol in combination with
Zoladex (
goserelin acetate) in women with subjective DUB, the duration of menstruation, the number of days of heavy
bleeding and objective blood loss were all significantly (P < 0.001) reduced. There was also significant (P < 0.001) symptomatic improvement. Furthermore, in 51 patients with symptomatic
uterine fibroids, combined oestrogen/
progestogen given for 21 months after initial
GnRH agonist treatment for 3 months did not promote
fibroid regrowth. In contrast, in women randomised to
progestogen only, there was a gradual increase in uterine volume. The combination of
GnRH agonists and add-back HRT appears beneficial for women with either DUB or
fibroids.