Immediate and delayed add-back hormonal replacement therapy during ultra long GnRH agonist treatment of chronic cyclical pelvic pain.
BJOG
; 116(12): 1646-56, 2009 Nov.
Article
en En
| MEDLINE
| ID: mdl-19735378
ABSTRACT
OBJECTIVE:
To assess the safety and efficacy of long-term use of long-acting GnRH agonist in women with chronic cyclical pelvic pain using immediate versus delayed add-back hormonal replacement therapy (HRT).DESIGN:
A prospective randomised trial.SETTING:
Reproductive and Developmental Medicine, Academic Unit, University Teaching Hospital and NHS Hospitals. POPULATION Thirty-eight premenopausal women with chronic cyclical pelvic pain were recruited.METHODS:
Women were given Zoladex 10.8 mg over 18 months and randomised to receive HRT (tibolone 2.5 mg) either immediately or after 6 months. Follow up was 12-month post-treatment. MAIN OUTCOMEMEASURES:
Bone mineral density at 6 months, the end of treatment (18 months), and 12 months later, pain and quality of life.RESULTS:
Women treated with immediate HRT add-back showed less bone mineral density loss at 6 months and less vasomotor symptoms compared with those who had delayed HRT add-back treatment. Long-term follow up showed both groups experienced equivalent bone mineral density loss. Pain and health-related quality-of-life assessment showed improvement in both groups but there was evidence of a return to baseline levels after ending treatment.CONCLUSION:
Long-term use of GnRH agonist plus immediate add-back HRT is a safe and acceptable approach to intractable cyclical pelvic pain. Given the delay in reactivation of the hypothalamo-pituitary-ovarian axis after long-term suppression, an intermittent dose regime with GnRH agonist might warrant investigation.
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Terapia de Reemplazo de Estrógeno
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Goserelina
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Dolor Pélvico
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Norpregnenos
Tipo de estudio:
Clinical_trials
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Adult
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Female
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Humans
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Middle aged
Idioma:
En
Año:
2009
Tipo del documento:
Article