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Extending the treatment boundaries: Zoladex and add‐back
Author(s) -
Schlaff W.D
Publication year - 1999
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/s0020-7292(98)00239-2
Subject(s) - medicine , progestogen , endometriosis , agonist , hormone replacement therapy (female to male) , bone mineral , gonadotropin releasing hormone agonist , endocrinology , hormone , buserelin , osteoporosis , testosterone (patch) , receptor
Objective : To review the evidence that add‐back hormone replacement therapy (HRT) can ameliorate the metabolic consequences of gonadotropin‐releasing hormone (GnRH) agonist treatment in women with symptomatic endometriosis. Methods : A review of relevant literature. Results : Early studies suggested that add‐back HRT maintained bone mineral density (BMD) without reducing the symptomatic benefit of GnRH treatment. Both high‐dose progestogen and low dose progestogen plus cyclical etidronate are effective in maintaining BMD. Standard and low dose HRT add‐back may be more effective in relieving the hypo‐estrogenic side‐effects of GnRH agonist therapy. Randomized controlled studies have shown that both low‐dose and standard‐dose add‐back HRT reduce the side‐effects of GnRH agonist therapy, and that this benefit extends to 12 months of treatment. Conclusions : GnRH agonist treatment with add‐back HRT seems to offer the hope of improved treatment for women with endometriosis, but the optimum treatment duration and time to start HRT have yet to be defined.