Endometriosis: Leuprolide in a 3-monthly versus a monthly depot formulation for the treatment of symptomatic endometriosis: a pilot study

Abstract

An open-label randomized pilot study was conducted to evaluate the efficacy and acceptability of 6 months treatment with leuprolide in a 3-monthly versus a monthly i.m. depot injection for the relief of chronic pelvic pain in women with endometriosis. A total of 30 women aged 18-38 years were allocated to the 3-monthly depot arm (n = 15) or to the monthly depot arm (n = 15) after laparoscopic diagnosis of pelvic endometriosis. Mean (SD) deep dyspareunia scores according to a 0-3 point verbal rating scale decreased from 1.8 (0.9) at baseline to 1.3 (0.7) at the end of treatment in the 3-monthly depot group and from 2.1 (1.2) to 1.3 (0.7) in the monthly depot group. Corresponding values in non-menstrual pain scores fell from 2.1 (0.6) to 1.1 (0.3), and from 2.1 (0.8) to 1.2 (0.4) respectively, without statistically significant differences between the groups. Serum luteinizing hormone (LH) and 17 beta-oestradiol concentrations were significantly suppressed at 12 and 24 weeks compared with baseline values, without differences between the groups. The monthly depot caused a slightly more marked inhibition of serum follicle stimulating hormone (FSH) levels with respect to the 3-monthly preparation. Mean (SD) endometriosis scores at baseline and at 6-month follow-up laparoscopy were respectively 32.8 (25.1) and 12.2 (9.3) in the 3-monthly depot group and 29.0 (22.7) and 13.1 (15.3) in the monthly depot group (paired t-test, P< 0.05). Mean percentage decrease in lumbar spine bone mineral density was 5.2% in the former and 4.9% in the latter subjects. In the 3-monthly depot group, 13 women graded the tolerability of their treatment schedule as "good' compared with seven in the monthly depot group (chi 2 = 5.40, P = 0.02).

Treatment of endometriosis in different ethnic populations: a meta-analysis of two clinical trials

“…There appears to be no published literature that directly compares leuprolide acetate and buserelin acetate in endometriosis, but a review by the Cochrane Collaboration [25] suggests that, in similar trials, 24 weeks of treatment with buserelin acetate was associated with twice the BMD loss that was seen with leuprolide acetate [53,54]. However, these trials were conducted in different ethnic groups and the methods used for BMD analysis differed.…”

Endometriosis: associations with menopause, hormone replacement therapy and cancer

“…Many descriptive studies have concluded that add-back HRT in the form of estrogens or estrogen plus progesterone is protective against bone loss. 43,44 Endometriosis and surgical menopause There appear to be significant variations in terms of surgical management especially in those women undergoing a hysterectomy for known, longstanding endometriosis. The dilemma arises in relation to the simultaneous removal of the ovaries as most of these women are young.…”

“…Many descriptive studies have concluded that add-back HRT in the form of estrogens or estrogen plus progesterone is protective against bone loss. 43,44…”

Mammographic breast density in infertile and parous women

“…Infertility is defined as the failure to conceive after one year of regular unprotected intercourse, and prevalence is approximately 10 %-15 % in Western countries [1]. The demand for infertility services is steadily increasing, and so is the average age of women undergoing in vitro fertilization (IVF) [2, 3].…”