Metabolic changes during medical treatment of endometriosis: Nafarelin acetate versus danazol

Burry, Kenneth A.; Patton, Phillip E.; Illingworth, D. Roger

doi:10.1016/0002-9378(89)90870-3

Cited by 39 publications

(11 citation statements)

References 19 publications

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“…These lipoprotein changes were not deemed to be atherogenic. In contrast, a significant decrease in HDL concentrations and a significant increase in LDL levels were observed during therapy with danazol 13,14 .…”

Section: Metabolic Side‐effects: Safety Issuesmentioning

confidence: 84%

The role of GnRH analogues in the treatment of endometriosis

Shaw

1992

BJOG

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Section: Metabolic Side‐effects: Safety Issuesmentioning

confidence: 84%

The role of GnRH analogues in the treatment of endometriosis

Shaw

1992

BJOG

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“…Danazol at daily doses of 400 to 800 mg orally leads to weight gain (31,45) and induces androgenic side-effects (acne, oily skin and hair, seborrhea) (31,44,(49)(50)(51)(52). It also adversely affects lipids, lipoproteins (49,(53)(54)(55)(56) and liver function (51,56,57). Danazol treatment has been observed to be associated with altered concentrations of plasma HDL-cholesterol, LDL-cholesterol and apolipoproteins A-I, A-2 and B in a way which may indicate an increased risk as regards atherosclerotic changes (54).…”

Section: Danazol a Drug Of Standard Therapy And A Reference Drug In mentioning

confidence: 99%

“…Soon after the start of therapy, patients experience hot flushes and other neurovegetative symptoms of menopause, and they are at risk of bone mineral loss (96). Concentrations of plasma lipids and lipoproteins remain unchanged or show small alterations regarded as being beneficial (49,55).…”

Section: Gnrh Ugonist Analogues Versus Dunuzolmentioning

confidence: 99%

Changing concepts of medical treatment of endometriosis

Kauppila

1993

Acta Obstet Gynecol Scand

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Studies on the natural history of endometriosis have demonstrated that the majority of endometriosis implants tend to progress, a finding that indicates eradication of the lesions by medical and/or surgical approaches. Infertility and dysmenorrhea are other indications for medical therapy in this disease. In recent prospective and controlled studies, progestin (at high doses), gestrinone and GnRH agonist analogues have been equally effective as regards elimination of endometriosis and relief of endometriosis-associated symptoms, compared to danazol, a standard treatment in endometriosis. These four classes of drugs differ, however, in their adverse effects and as regards compliance. Danazol is a steroid with androgenic and anabolic effects and it adversely affects lipid metabolism. Gestrinone and 17-OH progestins are weaker, and GnRH agonist analogues and some progestins neutral in these respects. GnRH agonist analogues induce a hypo-estrogenic state with associated climacteric symptoms and mineral loss from the bones. The clinical value of combinations of GnRH analogue and steroid(s), used to prevent these side-effects, is so far unclear. Laparoscopic microsurgery has revolutionized the treatment of endometriosis lesions. Hence, hormone treatment as a supplement to microsurgical approaches may become a dominant form of medical therapy in endometriosis. The definitive value of pre- or post-operative hormonal treatment in this disease should, however, be tested in controlled trials. Such studies have proved antiprostaglandins to be useful in the treatment of dysmenorrhea secondary to endometriosis. Because each of the four drugs was ineffective in the treatment of infertility associated with endometriosis it is a waste of time to expose patients desiring pregnancy to long-term hormonal therapy. Ovarian hyperstimulation with IVF and other methods of assisted fertilisation are promising alternatives, but their definitive value is so far unproven in this disease. Conclusively, the significance of medical therapy in endometriosis is only partly resolved, and therefore, many therapeutic problems await prospective randomised trials and new innovations.

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“…Chemical parameters of bone turnover, such as urinary calciumxreatinine, urinary hydroxyproline:creatinine, and serum alkaline phosphatase, have also been shown to increase significantly with GnRH agonist treatment and to return to baseline levels relatively early. 2 -1 "'" 30 These indices, however, do not provide direct information on the quantity of bone loss and, therefore, tend to be less clinically useful.…”

Section: Untoward Effects Of Iatrogenic Hypoestrogenemia: Safety Issumentioning

confidence: 99%

The Role of GnRH Agonists Plus Add-Back Therapy in the Treatment of Endometriosis

Gargiulo¹,

Hornstein²

1997

Semin Reprod Med

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Agonistic analogs of GnRH have emerged as effective drugs in the treatment of pelvic pain associated with endometriosis. Iatrogenic hypoestrogenism is the fundamental mechanism through which GnRH agonists induce regression of the exquisitely estrogen-dependent endometriotic lesions. The decrease in bone mass consistently observed in women on long-term GnRH agonist treatment has prompted regulatory agencies such as the FDA to approve the use of these drugs for a maximum of six months in the treatment of endometriosis. The very high recurrence rate of pelvic symptomatology after the interruption of medical therapy underlines the importance of strategies aiming at improving the safety of effective long-term treatments. Data has recently become available suggesting the existence of an ideal range of circulating estradiol levels which would maintain a normal bone metabolism and still cause atrophy of endometriotic lesions. Add-back regimens including estrogen preparations have been therefore studied with variable results. In strict analogy, as oral progestins have been shown to improve bone mass in postmenopausal women, regimens employing progestin add-back have been proposed. Our review describes most of the currently published studies employing these and other substances in association with the commonly used GnRH agonists in patients with symptomatic endometriosis.

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Metabolic changes during medical treatment of endometriosis: Nafarelin acetate versus danazol

Cited by 39 publications

References 19 publications

The role of GnRH analogues in the treatment of endometriosis

The role of GnRH analogues in the treatment of endometriosis

Changing concepts of medical treatment of endometriosis

The Role of GnRH Agonists Plus Add-Back Therapy in the Treatment of Endometriosis

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