Clinical outcome of various regimens of gonadotropin-releasing hormone analogues after conservative surgery in patients with endometriosis

Objective: To assess the efficacy of three GnRHa therapies after conservative surgery for ovarian endometriosis by analyzing sex hormones, hypo-estrogenic symptoms, quality of life and bone mineral density. Methods: Thirty-six ovarian endometriosis patients with 20 to 48 years old were divided into three groups after conservative surgery according to their own wills. GnRHa conventional dosage regimen group was intramuscularly injected of triptorelin 3.75 mg every 4 weeks. Tibolone ‘add-back’ therapy group received the same treatment as the conventional group and orally took tibolone tablets 1.25 mg/d from the eighth week. GnRHa extended-interval dosage group received a 4-dose regimen every 6 weeks. The treatment lasted for 24 weeks. The EMs (VAS score), menopausal score, recurrence, menstruation and vaginal bleeding were assessed. The levels in sex hormones, bone metabolism indicators, lumbar spine bone mineral density, CA125 and other parameters were observed. Results: The symptoms including dysmenorrhea, dyspareunia and chronic pelvic pain were relieved in three groups. At 12th and 24th week of GnRHa treatment, the levels of serum sex hormones (FSH, LH and E2) in all groups were decreased compared with the baseline, the modified Kupperman scores in Tibolone ‘add-back’ group and extended-interval group were lower than those of the conventional group. At the end of the 24th week, T scores and CA125 serum in all groups were decreased compared with the baseline. Conclusions: Tibolone ‘add-back’ therapy and GnRHa extended-interval regimen had better effects on improving symptoms of perimenopause than GnRHa conventional regimens. Tibolone ‘add-back’ therapy was more effective in protection of bone density than other treatments.