Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples "Federico II" , Naples, Italy.
Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino , Genoa, Italy.
Expert Opin Drug Metab Toxicol. 2020 Sep;16(9):759-768. doi: 10.1080/17425255.2020.1789591. Epub 2020 Jul 12.
The second-line treatment of endometriosis-related pain symptoms includes injectable depot formulations of gonadotropin-releasing hormone analogs (GnRH-as). These drugs improve the symptomatology by inducing a hypoestrogenic status and a consequent regression of endometriotic implants. However, GnRH-a may cause a not negligible rate of adverse events, in particular vasomotor symptoms and bone mineral density loss, that may limit patients' adherence and safety on long-term treatment. Several strategies have been suggested to improve the compliance to treatment.
This narrative review aims to give an overview of the safety and tolerability of GnRH-a therapy and to present the different options of steroidal and non-steroidal add-back therapies in order to reduce the hypoestrogenic side effects.
Side effects of long term GnRH-a treatment are particularly relevant. Although it has been known the efficacy of GnRH-as for treating endometriosis-associated pain, the best schedules of therapy in terms of duration and dosages are still to be defined. The ideal treatment schedule of GnRH-a is still a matter of debate as to the optimal add-back combination.
内异症相关疼痛症状的二线治疗包括促性腺激素释放激素类似物（GnRH-a）的注射用缓释制剂。这些药物通过诱导雌激素缺乏和随之而来的子宫内膜异位症病灶退化来改善症状。然而，GnRH-a 可能会引起相当比例的不良反应，特别是血管舒缩症状和骨密度丢失，这可能会限制患者在长期治疗中的依从性和安全性。已经提出了几种策略来提高治疗的依从性。
本综述旨在概述 GnRH-a 治疗的安全性和耐受性，并介绍不同的甾体和非甾体添加治疗选择，以减少雌激素缺乏的副作用。
长期 GnRH-a 治疗的副作用尤其值得关注。尽管人们已经了解 GnRH-as 治疗内异症相关疼痛的疗效，但在治疗时间和剂量方面，最佳的治疗方案仍有待确定。GnRH-a 的理想治疗方案仍存在争议，最佳的添加组合尚不确定。
