Add-Back and Combined Regulation in GnRH-a Treatment of Endometriosis

Objective: The purpose of this review is to summarize drug selection for peri-menopausal symptoms caused by gonadotropin releasing-hormone agonist (GnRH-a) in the treatment of endometriosis. Mechanism: GnRH-a treatment often leads to low estrogen levels, resulting in peri-menopausal symptoms and osteoporosis. Add-back therapy relieves clinical symptoms by supplementing low-dose estrogen. The idea of "combined regulation" is to improve symptoms by adding plant preparations or proprietary Chinese medicines. Studies have shown that they may play a role by regulating serotonin activity. Findings in Brief: For patients treated with GnRH-a for less than 3 months, the combined-regulation regimen can be considered, whereas for patients who have had more than 3 courses of GnRH-a, add-back therapy with sex hormones must be used because the patients will have begun to have obvious bone-mass loss and even bone pain; this bone-mass loss is often irreversible. Conclusions: In the early treatment of endometriosis with GnRH-a, non-hormone combined-regulation therapy is a relatively safe and feasible choice, but hormone add-back therapy should be selected for patients who have had more than 3 courses of GnRH-a.