Surrey E S
Department of Obstetrics and Gynecology, University of California, Los Angeles School of Medicine, USA.
Gynecol Obstet Invest. 1998;45 Suppl 1:31-4; discussion 35. doi: 10.1159/000052849.
GnRH analogues have been demonstrated to be effective medical therapy for symptomatic endometriosis. The use of these agents has been limited to 6 months due to hypoestrogenic side effects. A variety of steroidal and nonsteroidal add-back regimens have been used in an effort to eliminate such side effects while maintaining efficacy in order to enhance compliance, safety and duration such side effects while maintaining efficacy in order to enhance compliance, safety and duration of administration of these agents. Only 3 regimens have been shown to be efficacious in prolonging analogue use beyond 6 months by reducing vasomotor symptoms as well as preventing significant bone mineral density loss. These include daily norethindrone acetate 5 mg alone or in conjunction with conjugated equine estrogens 0.625 mg daily, as well as norethindrone 2.5 mg daily in conjunction with an organic bisphosphonate. With further investigation, such regimens may allow safe prolongation of GnRH analogue use without sacrificing efficacy in those endometriosis patients with severe pelvic pain.
促性腺激素释放激素（GnRH）类似物已被证明是治疗有症状子宫内膜异位症的有效药物疗法。由于低雌激素副作用，这些药物的使用期限被限制在6个月。为了消除此类副作用同时保持疗效，从而提高这些药物使用的依从性、安全性及用药时长，人们使用了多种甾体和非甾体的补充治疗方案。只有3种方案被证明可有效延长类似物的使用时间至6个月以上，它们能减轻血管舒缩症状并防止骨矿物质密度显著流失。这些方案包括每日单独使用5毫克醋酸炔诺酮或与每日0.625毫克结合马雌激素联合使用，以及每日2.5毫克炔诺酮与一种有机双膦酸盐联合使用。随着进一步研究，此类方案可能会使GnRH类似物在不牺牲疗效的情况下安全延长使用时间，适用于那些患有严重盆腔疼痛的子宫内膜异位症患者。
