Journal List > Korean J Obstet Gynecol > v.55(6) > 1088455

TOOLS
Joo, Jung, Kim, and Lee: Quality of life according to add-back therapy during GnRH agonist treatment in endometriosis patients
Original Article
Korean Journal of Obstetrics & Gynecology

Korean Journal of Obstetrics & Gynecology 2012; 55(6): 371-377.

Published online: 16 June 2012

DOI: https://doi.org/10.5468/KJOG.2012.55.6.371

Quality of life according to add-back therapy during GnRH agonist treatment in endometriosis patients

Jong Kil Joo, MD, In Kook Jung, MD, Ki Hyung Kim, MD, Kyu Sup Lee, MD

Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, Korea.

Corresponding author: Ki Hyung Kim, MD. Department of Obstetrics and Gynecology, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan 602-739, Korea. Tel: +82-51-240-7287, Fax: +82-51-248-2384, ghkim@pusan.ac.kr

Received 13 January 2012       Revised 15 March 2012       Accepted 3 May 2012

Copyright © 2012. Korean Society of Obstetrics and Gynecology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

This study was performed to investigate the effect of add-back therapy on quality of life during postoperative gonadotropin-releasing hormone (GnRH) agonist therapy for endometriosis.

Methods

Fifty-one patients who were diagnosed as stage III/IV endometriosis after laparoscopic ovarian cystectomy from January 2009 to December 2010 were divided into GnRH agonist with add-back therapy group and GnRH agonist only group. Add-back therapy was started before third injection of GnRH agonist. Short form health survey (SF-36) instrument was checked preoperatively, at the time of 6th GnRH agonist therapy and 6 months after GnRH agonist therapy.

Results

There were no differences between two groups on the mean age, body mass index and revised American Fertility Society score. In most cases, add-back therapy was added because of menopausal symptoms. Pelvic pain and dysmenorrhea showed no differences between two groups on each survey period. At the time of 6th GnRH agonist therapy, physical function in add-back therapy group was improved significantly compared with preoperative period (85.7±8.8 vs. 91.0±10.4, P=0.011). In GnRH only group, physical function at preoperative period was rather higher than at the time of 6th GnRH agonist therapy.

Conclusion

Add-back therapy during postoperative GnRH agonist therapy showed no negative effect on pelvic pain and dysmenorrhea. Physical function was improved in add back group. Add-back therapy might have an influence on quality of life in patients receiving postoperative GnRH agonist therapy for endometriosis.

Keywords: Endometriosis, Add-back, Quality of life

Figures and Tables

Fig. 1
Causes of no add-back therapya (n = 27). aMultiple causes included.
kjog-55-371-g001
Table 1
Basic characteristics of patients
kjog-55-371-i001

Values are presented as mean ± standard deviation or number of patients.

Table 2
Drugs and causes of add-back therapy
kjog-55-371-i002

aMultiple causes included.

Table 3
Effects of add-back therapy on pelvic pain and dysmenorrhea
kjog-55-371-i003

Values are presented as mean ± standard deviation.

Pelvic pain and dysmenorrhea values are expressed in visual analogue scale units.

P<0.001, between (A) and (B), (A) and (C), (D) and (E), (a) and (b), (a) and (c), (d) and (e); P=0.447, between (B) and (C); P=0.476, between (b) and (c).

Table 4
Differences in the patients quality of life, as assessed by SF-36, before and after treatment
kjog-55-371-i004

Values are presented as mean ± standard deviation.

SF-36, short form health survey; Preop., preoperative; At 6th GnRHa, at the time of 6th gonadotropin-releasing hormone agonist injection; 6 mo. F/U, 6 months after completion of GnRH agonist; NS, not significant.

a(A) vs. (B), b(A) vs. (C), c(B) vs. D, d(C) vs. (D).

References

1. Olive DL, Schwartz LB. Endometriosis. N Engl J Med. 1993. 328:1759–1769.
2. Park HM, Lee WS, Song MS, Hur M. The effect of progesterone add-back therapy on skeletal status during GnRH agonist therapy for endometriosis. Korean J Obstet Gynecol. 2003. 46:288–295.
3. Batzer FR. GnRH analogs: options for endometriosis-associated pain treatment. J Minim Invasive Gynecol. 2006. 13:539–545.
4. Olive DL. Gonadotropin-releasing hormone agonists for endometriosis. N Engl J Med. 2008. 359:1136–1142.
5. Kiilholma P, Tuimala R, Kivinen S, Korhonen M, Hagman E. Comparison of the gonadotropin-releasing hormone agonist goserelin acetate alone versus goserelin combined with estrogen-progestogen add-back therapy in the treatment of endometriosis. Fertil Steril. 1995. 64:903–908.
6. Fernandez H, Lucas C, Hédon B, Meyer JL, Mayenga JM, Roux C. One year comparison between two add-back therapies in patients treated with a GnRH agonist for symptomatic endometriosis: a randomized double-blind trial. Hum Reprod. 2004. 19:1465–1471.
7. Friedman AJ, Hornstein MD. Gonadotropin-releasing hormone agonist plus estrogen-progestin "add-back" therapy for endometriosis-related pelvic pain. Fertil Steril. 1993. 60:236–241.
8. McHorney CA, Ware JE Jr, Raczek AE. The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care. 1993. 31:247–263.
9. Jenkinson C, Coulter A, Wright L. Short form 36 (SF36) health survey questionnaire: normative data for adults of working age. BMJ. 1993. 306:1437–1440.
10. Valle RF, Sciarra JJ. Endometriosis: treatment strategies. Ann N Y Acad Sci. 2003. 997:229–239.
11. Jee BC, Lee JY, Suh CS, Kim SH, Choi YM, Moon SY. Impact of GnRH agonist treatment on recurrence of ovarian endometriomas after conservative laparoscopic surgery. Fertil Steril. 2009. 91:40–45.
12. Barbieri RL. Hormone treatment of endometriosis: the estrogen threshold hypothesis. Am J Obstet Gynecol. 1992. 166:740–745.
13. Fuldeore MJ, Marx SE, Chwalisz K, Smeeding JE, Brook RA. Add-back therapy use and its impact on LA persistence in patients with endometriosis. Curr Med Res Opin. 2010. 26:729–736.
14. Olive DL. The role of add-back therapy in the United States. Drugs Today (Barc). 2005. 41:Suppl A. 23–26.
15. Zupi E, Marconi D, Sbracia M, Zullo F, De Vivo B, Exacustos C, et al. Add-back therapy in the treatment of endometriosis-associated pain. Fertil Steril. 2004. 82:1303–1308.
16. Surrey ES. Add-Back Consensus Working Group. Add-back therapy and gonadotropin-releasing hormone agonists in the treatment of patients with endometriosis: can a consensus be reached? Fertil Steril. 1999. 71:420–424.
17. Kim NY, Ryoo U, Lee DY, Kim MJ, Yoon BK, Choi D. The efficacy and tolerability of short-term low-dose estrogen-only add-back therapy during post-operative GnRH agonist treatment for endometriosis. Eur J Obstet Gynecol Reprod Biol. 2011. 154:85–89.
18. Morris EP, Rymer J, Robinson J, Fogelman I. Efficacy of tibolone as "add-back therapy" in conjunction with a gonadotropin-releasing hormone analogue in the treatment of uterine fibroids. Fertil Steril. 2008. 89:421–428.
19. Surrey ES. Gonadotropin-releasing hormone agonist and add-back therapy: what do the data show? Curr Opin Obstet Gynecol. 2010. 22:283–288.
20. Al-Azemi M, Jones G, Sirkeci F, Walters S, Houdmont M, Ledger W. Immediate and delayed add-back hormonal replacement therapy during ultra long GnRH agonist treatment of chronic cyclical pelvic pain. BJOG. 2009. 116:1646–1656.
TOOLS
Similar articles