Comparison of the gonadotropin-releasing hormone agonist goserelin acetate alone versus goserelin combined with estrogenprogestogen add-back therapy in the treatment of endometriosis

Citations from the literature /International Journal of Gynecology & Obstetrics 53 (19%) 305-316 further 12 months’ follow-up and are compared between the two groups. A total of 15 patients from the gestrinone group, including four patients with hirsutism, and 17patients from the danazol group, including six patients with headache,withdrew becauseof adverse symptoms. An additional 22 patients, including 10from the gestrinone group and 12 from the danaxol group withdrew becauseof lack of efficacy, pregnancy, elevated hepatic function testsor for reasonsmu-elatedto the trial. Total American Fertility Society scoring showed an improvement of 73.3%in 1Ol‘patients receiving gestrinone and 72.7% in 99 patients receiving danaxol. The results showeda significant reduction in the severity of dysrnenorrhoeaby the third month in the danaxol group and at 6 months in both groups. There was a significant (P < 0.001)increasein weight observed in both groups during treatment. Overall, the tolerability of danaxol and gestrinonewas good, however, significantly more patients with gestrinone complained of hirsutism while significantly more with danazol complained of leg cramps. During the 12 months of follow-up, mild, moderate or severedegreesof lower abdominal pain, dysmenorrhoea and deep dyspareunia all fluctuated, with no statistically significant increase in frequency in either group. Updnthgtbecihidexpaience&domelriosis-The BraaBh pampedve Halbe H.W.; Nakamura MS.; Da Silveira G.P.G.; Carvalho W.P.C. BRA BR J OBSTET GYNAECOL SUPPL 1995 10202 (17-21) In an open-label, multicentre, randomized, parallel group study, 164 women with endometriosis were assigned to treatment. Out of these women, 81 received danazol(600 mg daily for 8 weeks, then 400 mg for 16 weeks) and 83 were given gestrinone (2.5 mg twice a week for 24 weeks). Five weeks before the start of treatment clinical evaluation and diagnostic laparoscopy were performed during the screening visit. Drug assignment and laboratory data assessmentwere carried out within 3 days of the estimated onset of the menstrual cycle at baseline visit. The response to treatment was assessedduring visits at weeks2,4,8, 12, 16,20 and 24, at the last visit a second laparoscopy was performed. Therapeutic efficacy was evaluated by analysis of the laparoscopic scores assessedaccording to the revised American Fertility Society classification. Symp tomatic responsewas measured by clinical scores and laboratory data. In one centre, bone mineral density was also recorded. One patient in the danaxol group discontinued treatment due to a cutaneousrash as a probable adverse reaction at the beginning of the study. The therapeutic efficacy of danaxol and gestrinone did not differ significantly when the revised American Fertility Society scores were compared. The symp tomatic response also showed no statistical difference when clinical examination scoreswere analysed. There was no significant difference between the drugs in laboratory data, including bone mineral density, with respect to adverse events. Analysis of clinical scores showed that danazol was superior to gestrinone with respect to acne and irregular bleeding. Based on these data, we conclude that both danaxol and gestrinone

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are reliable in the treatment of endometriosis and offer similar results. comparlaao of the Wk-iwI=-=~ WItIl estrogelb pmgdgenadd4mcktbuclpyinthetreatmemtofendometi~ Kiilholma P.; Tuimala R.; Kivinen S.; Korhonen M.; Hagman E. FIN FERTIL STERIL 19956415(903-908) Objective: To investigate whether the addition of low-dose estrogen-Pcombination hormone replacement therapy (HRT) to GnRH agonist (GnRH-a) treatment for endometriosis reduces the pharmacologic side effects of such treatment without reducing efftcacy and to determine the endocrinologic changes during treatment. Design: Prospective, random&d, double-blind, placebo-controlled, comparative study of two drug regimens: 3.6 mg goserelin acetate in a 28day SC depot formulation once monthly for 6 months plus either a combination of 2 mg 17& Ez and 1 mg norethisterone acetate (NET) 1 mg or matching placebo tablets once daily for 6 months. Setting: Multicenter study in three tertiary referral centers at university teaching hospitals and two central hospitals. Patients: Women with laparoscopically confirmed symptomatic endometriosiswere included in the study. Results: Of the total of 109patients screened,93 were recruited and 88 patients were randomized to either the HRT or the placebo group. Four women were withdrawn because of various medical reasons, and 76 patients were followed-up for a total of 12 months. In terms of efficacy, there was no difference between the two drug regimens for objective or subjective response. There were significantly less postmenopausal symptoms in the patients treated with goserelin plus HRT compared with those treated with goserelin plus placebo. Conclusion: Goserelin diminished significantly the symptoms and laparoscopic scores of endomettiosis. The addition of HRT did not reduce the efficacy of goserelin but diminished the postmenopausalsymptoms during treatment. gOKdOW<O8lOOk?Verclps~IlO-

Inumme dy- A @edal target for treatment ln eadometriosis Gleicher N. USA BR J OBSTET GYNAECOL SUPPL 1995 102/12(4-7) The treatment approach towards endometriosis has been traditionally either surgical or hormonal in nature. Since endometriosis is, to a large extent, a microscopic disease,a surgical approach cannot be expected to eradicate the disease. Treatment is, therefore, generally attempted by hormonal manipulation, an approach based on the known oestrogen sensitivity of endometriosis. Hormonal manipulation can only temporarily atTectendometriosis, and quite clearly does not address the underlying aetiology and/or pathophysiology of the disease.Since neither is, at present, well understood, one can only speculateas to the treatment approach that would, in fact, affect the pathophysiology of the condition. Endometriosis has, in recent years, been character&d by a large number of im-