Can hormone replacement therapy be used during medical therapy of endometriosis?

Edmonds, D. Keith; Howell, Rosemary

doi:10.1111/j.1471-0528.1994.tb13681.x

Cited by 26 publications

(7 citation statements)

References 10 publications

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“…In the endometriosis model, a 6-month prospective randomized trial of 50 patients treated with GnRH-a and placebo or transdermal estradiol patches 25 mg twice weekly and MPA 5 mg daily has been reported [18]. Similar improvement in disease and pain scores was noted in both treatment groups, but a significant reduction in hot flushes was noted in the add-back group.…”

Section: Role Of Add-back Therapy In Gynecologymentioning

confidence: 68%

Add-Back Therapy: Extending Safety and Efficacy of GnRH Analogues in the Gynecologic Patient

Surrey¹

1998

Gynecol Obstet Invest

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GnRH analogues have been demonstrated to be effective medical therapy for symptomatic endometriosis. The use of these agents has been limited to 6 months due to hypoestrogenic side effects. A variety of steroidal and nonsteroidal add-back regimens have been used in an effort to eliminate such side effects while maintaining efficacy in order to enhance compliance, safety and duration such side effects while maintaining efficacy in order to enhance compliance, safety and duration of administration of these agents. Only 3 regimens have been shown to be efficacious in prolonging analogue use beyond 6 months by reducing vasomotor symptoms as well as preventing significant bone mineral density loss. These include daily norethindrone acetate 5 mg alone or in conjunction with conjugated equine estrogens 0.625 mg daily, as well as norethindrone 2.5 mg daily in conjunction with an organic bisphosphonate. With further investigation, such regimens may allow safe prolongation of GnRH analogue use without sacrificing efficacy in those endometriosis patients with severe pelvic pain.

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Section: Role Of Add-back Therapy In Gynecologymentioning

confidence: 68%

Add-Back Therapy: Extending Safety and Efficacy of GnRH Analogues in the Gynecologic Patient

Surrey¹

1998

Gynecol Obstet Invest

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“…The median durations of the disease symptoms were 1.5 years (range 0.1-16) in the nafarelin 200 pg group, 0.8 years (range 0.1-10) in the nafarelin 400 pg group and 0.5 years (range 0. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] in the nafarelin 200 pg plus norethisterone 1.2 mg group. There were no significant differences between groups concerning symptom scores or pelvic examination scores.…”

Section: Resultsmentioning

confidence: 99%

A double-blind randomized study of the treatment of endometriosis with nafarelin or nafarelin plus norethisterone

Bergqvist

Jacobson

Harris³

1997

Gynecological Endocrinology

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The objective of this study was to compare the efficacy of nafarelin 200 micrograms (Group A), nafarelin 400 micrograms (Group B) and the combination of nafarelin 200 micrograms and norethisterone 1.2 mg (Group C) daily, in treating symptoms of endometriosis, American Fertility Society score and adverse events during 6 months of treatment. A prospective, randomized, double-blind parallel group study was performed in two centers and 49 women with endometriosis diagnosed laparoscopically were included. The patients were seen monthly for physical examination and records were taken for bleeding pattern, symptom score and adverse events. A control laparoscopy was performed at the end of 6 months of treatment. All patients were followed 6 months after treatment. At 3 and 6 months the pelvic examination total score had decreased significantly in all three groups. The total endometriosis score was significantly reduced in Groups B and C. After 2 months the total symptom score showed a significant decrease in Groups B and C. The frequency of hot flushes during the first month of treatment was lowest in Group C, but during the rest of treatment there were no differences between the groups. Best bleeding control was obtained in Group C. We conclude that nafarelin 200 micrograms daily has as good an effect on endometriosis symptoms as nafarelin 400 micrograms daily, and the addition of norethisterone 1.2 mg results in fewer hot flushes and better bleeding control.

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“…There are very few cases reported of recurrence or development of endometriosis with HRT 52 except following the use of high‐dose synthetic 53 or unopposed conjugated oestrogens 51,54 . There are however several studies of HRT in endometriosis which indicate the beneficial effects of combined oestradiol‐progestogen add back therapy in combination with GnRH‐analogues 55–57 .…”

Section: Resultsmentioning

confidence: 99%

The mythology of hormone replacement therapy

Hartmann¹,

Huber²

1997

BJOG

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Objective To evaluate the literature on contraindications contained in pharmaceutical data sheets of five currently available oestrogen replacement preparations (HRT). These contraindications include cardiovascular disease, diabetes, liver diseases, otosclerosis, endometriosis, melanoma and hormone‐dependent tumours. Design Systematic review. Interventions Oestrogen replacement regimens. Results The contraindications to the five HRT preparations have been taken uncritically from the data sheets of oral contraceptives. In some of these conditions not only is HRT not contraindicated, it is indicated. The data sheets for the HRT preparations all state that cardiovascular disease is a contraindication, but systematic review shows that ischaemic heart disease, hypertension and hyperlipidaemia are not contraindications, and in ischaemic heart disease HRT may actually be indicated. Similarly, systematic review shows that diabetes, chronic liver disease, endometriosis, some cases of treated cancer of the endometrium and breast, melanoma and otosclerosis are not contraindications to HRT. Conclusions The information in the pharmaceutical data sheets of HRT regimens should be modified as more accurate information could influence how these preparations are prescribed by doctors as well as affect patient compliance.

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Can hormone replacement therapy be used during medical therapy of endometriosis?

Cited by 26 publications

References 10 publications

Add-Back Therapy: Extending Safety and Efficacy of GnRH Analogues in the Gynecologic Patient

Add-Back Therapy: Extending Safety and Efficacy of GnRH Analogues in the Gynecologic Patient

A double-blind randomized study of the treatment of endometriosis with nafarelin or nafarelin plus norethisterone

The mythology of hormone replacement therapy

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