OBJECTIVE: A meta-analysis was conducted to determine the effectiveness of using gonadotropin-releasing hormone analogues (GnRH-a), both with and without hormonal add-back therapy, for the management of endometriosis. METHODS: Cochrane library, Ovid (Embase) and Pubmed databases were searched between the years 1998 and 2013 for published, prospective, randomised controlled trials (RCT) that assessed the effectiveness of "add-back" therapy for EMs treatment. The meta-analysis was performed using RevMan V5.0. The main outcome measures were as follows: lumbar spine bone mineral density (BMD) immediately after treatment and after 6 months of follow-up; femoral neck BMD; serum estradiol levels; changes in the Kupperman index score; the pelvic pain score, including dysmenorrhoea and dyspareunia; and pelvic tenderness. RESULTS: A total of 13 RCT, including 945 participants, were identified. The evidence suggested that "add-back" therapy was more effective for symptom relief than GnRH-a alone. BMD was significantly different when comparing "add-back" therapy to GnRH-a alone, both immediately after treatment and at 6 months. The "add-back" therapy increased serum oestrogen and did not reduce the efficacy of GnRH-a for treating dysmenorrhoea and dyspareunia. A variety of add-back regimens had a same effect for the treatment of endometriosis. CONCLUSIONS: "Add-back" therapy, based on the GnRH-a dose, does not reduce the efficacy of using GNRH-a for the management of endometriosis. "Add-back" therapy reduced the occurrence of side effects that can occur with GnRH-a therapy alone, such as osteoporosis and menopausal syndrome. There were no statistically significant differences when comparing the effectiveness of a variety of "add-back" regimens to each other.
OBJECTIVE: A meta-analysis was conducted to determine the effectiveness of using gonadotropin-releasing hormone analogues (GnRH-a), both with and without hormonal add-back therapy, for the management of endometriosis. METHODS: Cochrane library, Ovid (Embase) and Pubmed databases were searched between the years 1998 and 2013 for published, prospective, randomised controlled trials (RCT) that assessed the effectiveness of "add-back" therapy for EMs treatment. The meta-analysis was performed using RevMan V5.0. The main outcome measures were as follows: lumbar spine bone mineral density (BMD) immediately after treatment and after 6 months of follow-up; femoral neck BMD; serum estradiol levels; changes in the Kupperman index score; the pelvic pain score, including dysmenorrhoea and dyspareunia; and pelvic tenderness. RESULTS: A total of 13 RCT, including 945 participants, were identified. The evidence suggested that "add-back" therapy was more effective for symptom relief than GnRH-a alone. BMD was significantly different when comparing "add-back" therapy to GnRH-a alone, both immediately after treatment and at 6 months. The "add-back" therapy increased serum oestrogen and did not reduce the efficacy of GnRH-a for treating dysmenorrhoea and dyspareunia. A variety of add-back regimens had a same effect for the treatment of endometriosis. CONCLUSIONS: "Add-back" therapy, based on the GnRH-a dose, does not reduce the efficacy of using GNRH-a for the management of endometriosis. "Add-back" therapy reduced the occurrence of side effects that can occur with GnRH-a therapy alone, such as osteoporosis and menopausal syndrome. There were no statistically significant differences when comparing the effectiveness of a variety of "add-back" regimens to each other.
Authors: Stefanie Burghaus; Sebastian D Schäfer; Matthias W Beckmann; Iris Brandes; Christian Brünahl; Radek Chvatal; Jan Drahoňovský; Wojciech Dudek; Andreas D Ebert; Christine Fahlbusch; Tanja Fehm; Peter Martin Fehr; Carolin C Hack; Winfried Häuser; Katharina Hancke; Volker Heinecke; Lars-Christian Horn; Christian Houbois; Christine Klapp; Heike Kramer; Harald Krentel; Jan Langrehr; Heike Matuschewski; Ines Mayer; Sylvia Mechsner; Andreas Müller; Armelle Müller; Michael Müller; Peter Oppelt; Thomas Papathemelis; Stefan P Renner; Dietmar Schmidt; Andreas Schüring; Karl-Werner Schweppe; Beata Seeber; Friederike Siedentopf; Horia Sirbu; Daniela Soeffge; Kerstin Weidner; Isabella Zraik; Uwe Andreas Ulrich Journal: Geburtshilfe Frauenheilkd Date: 2021-04-14 Impact factor: 2.915
Authors: Sanjay K Agarwal; AnnaMarie Daniels; Steven R Drosman; Laurence Udoff; Warren G Foster; Malcolm C Pike; Darcy V Spicer; John R Daniels Journal: Biomed Res Int Date: 2015-12-31 Impact factor: 3.411
Authors: Nicholas Leyland; Stephanie J Estes; Bruce A Lessey; Arnold P Advincula; Hugh S Taylor Journal: J Womens Health (Larchmt) Date: 2020-09-22 Impact factor: 2.681