Gonadotropin-Releasing Hormone Agonists for Endometriosis

• Published in: The New England journal of medicine Vol. 359; no. 11; pp. 1136 - 1142
• Main Author: Olive, David L
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 11.09.2008
• Subjects: Adult; Biological and medical sciences; Bone Density - drug effects; Cytokines; Endometriosis; Endometriosis - complications; Endometriosis - drug therapy; Female; Fundamental and applied biological sciences. Psychology; General aspects; Gonadotropin-Releasing Hormone - adverse effects; Gonadotropin-Releasing Hormone - agonists; Gonadotropin-Releasing Hormone - therapeutic use; Humans; Infertility; Medical sciences; Menstruation; Pain; Pain - etiology; Practice Guidelines as Topic; Transplants & implants; Vertebrates: endocrinology; Women; United States > US; Hormone; Medicine; Agonist; Uterine diseases; Endometriosis; Gonadotropin; Female genital diseases
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMct0803719

A 36-year-old woman with a presumptive diagnosis of endometriosis presents with long-standing pelvic pain that is not relieved by means of oral contraceptives or medroxyprogesterone. Treatment with a gonadotropin-releasing hormone agonist is recommended. Gonadotropin-releasing hormone agonists profoundly suppress gonadotropin secretion and sex-steroid production. Side effects include loss of bone mineral density and memory impairment. Gonadotropin-releasing hormone agonists profoundly suppress gonadotropin secretion and sex-steroid production. Side effects include loss of bone mineral density and memory impairment. Foreword This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are reviewed. Relevant formal guidelines, if they exist, are presented. The article ends with the author's clinical recommendations. Stage A 36-year-old woman presents with long-standing pelvic pain, including dysmenorrhea and pain with intercourse. She has previously received oral contraceptives and depot medroxyprogesterone for presumed endometriosis. This regimen has not relieved her pain, and she has had side effects, including continual abnormal uterine bleeding and fluid retention. She is referred to a reproductive endocrinologist for further investigation and treatment. After a careful review and examination to rule out other explanations for the patient's symptoms, the endocrinologist recommends the use of a gonadotropin-releasing hormone agonist combined with norethindrone acetate as empirical treatment for endometriosis. The Clinical Problem Endometriosis is a . . .