Using GnRH analogues to reduce endometriosis recurrence after surgery: a double-edged sword (original) (raw)
2021, Gynecology and Pelvic Medicine
Gonadotropin-releasing hormone (GnRH) analogues, including both agonists and antagonists, are a second line therapy for treating endometriosis. They work by down-regulating the hypothalamicpituitary-gonadal axis, suppressing ovulation and reducing estrogen levels. GnRH analogues are effective, but they may have significant side effects such as decreased bone mineral density, hot flashes, and mood or sleep disturbances. Due to these side effects, they should only be used for up to 1 year and with add back low dose estrogen and progesterone therapy. GnRH analogues are often used post-operatively to try to reduce endometriosis recurrence after surgery and the optimal duration is for 6 months. Research studies must be interpreted with caution as some do not have a control group for comparison, or the control group are women without treatment. Patients with deep infiltrating endometriosis (DIE) reporting deep dyspareunia may have significant improvement in sexual satisfaction and reduced pain after laparoscopic surgery for endometriosis followed by treatment with a GnRH agonist. After surgical removal of an endometrioma, suppressing ovulation can reduce endometrioma recurrence, but oral contraceptive pills or dienogest may be preferable over GnRH agonists due to improved side effect profiles. GnRH antagonists are a promising treatment for endometriosis pain in general, but there is little data available on using GnRH antagonists in the post-operative setting to reduce endometriosis recurrence. The European Society of Human Reproduction and Embryology (ESHRE) recommends using a levonorgestrel intrauterine system or a combined oral contraceptive for 18-24 months post-operatively to reduce dysmenorrhea pain in patients with endometriosis. Individualized patient counseling on risks and benefits as well as individual patient factors should be used to help select whether GnRH agonists are used post-operatively to prevent endometriosis recurrence.
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