Surrey Eric S
Colorado Center for Reproductive Medicine, Lone Tree, Colorado, USA.
Curr Opin Obstet Gynecol. 2010 Aug;22(4):283-8. doi: 10.1097/GCO.0b013e32833b35a7.
Endometriosis is a gynecologic disorder that can lead to debilitating chronic pelvic pain and infertility. Gonadotropin-releasing hormone agonists (GnRHa) have emerged as a primary medical therapy for patients with symptomatic disease, but secondary hypoestrogenic side effects may limit compliance. Add-back therapy is a means of surmounting this problem.
Progestins such as norethindrone acetate may be administered with or without addition of low doses of estrogens to safely and effectively extend GnRHa therapy while minimizing side effects. Recent studies have demonstrated that the use of add-back enhances compliance and duration of therapy. The initiation of an add-back should not be deferred given evidence demonstrating an increase in vasomotor symptoms and bone loss if not administered concomitantly. The subset of adolescents with endometriosis who require GnRHa therapy should be administered an add-back, but require careful monitoring of bone mineral density.
Implementation of an appropriately selected add-back will significantly reduce hypoestrogenic side effects, enhance compliance, and allow for prolongation of therapy without interfering with the efficacy of GnRHa in treating symptomatic endometriosis.
子宫内膜异位症是一种妇科疾病，可导致使人衰弱的慢性盆腔疼痛和不孕。促性腺激素释放激素激动剂（GnRHa）已成为有症状疾病患者的主要药物治疗方法，但继发性低雌激素副作用可能会限制依从性。添加疗法是解决这一问题的一种方法。
醋酸炔诺酮等孕激素可在添加或不添加低剂量雌激素的情况下给药，以安全有效地延长GnRHa治疗时间，同时将副作用降至最低。最近的研究表明，添加疗法可提高依从性和治疗持续时间。鉴于有证据表明，如果不同时给药，血管舒缩症状和骨质流失会增加，因此不应推迟添加疗法的开始。需要GnRHa治疗的子宫内膜异位症青少年亚组应给予添加疗法，但需要仔细监测骨密度。
实施适当选择的添加疗法将显著减少低雌激素副作用，提高依从性，并允许延长治疗时间，而不会干扰GnRHa治疗有症状子宫内膜异位症的疗效。
