Add-back therapy

GnRH agonist plus add-back therapy Very good Very long-term data unknown IM, os Long term Very expensive... 

Like the medical treatment of uterine leiomyomas, danazol, gestrinone, mifepristone, and GnRH-a, with or without add-back therapy, have been proposed for the treatment of endometriosis as well (Olive et al. 2001 Stones et al. 2004), but unlike leiomyomas, oral contraceptive pills, in cyclic or continuous administration, and medroxyprogesterone acetate also seem to be effective (Olive et al. 2001 Stones et al. 2004). A significant benefit in terms of pelvic pain relief also is obtained with the use of nonsteroidal anti-inflammatory drugs (Olive et al. 2001 Stones et al. 2004). 

Pickersgill A (1998) GnRH agonists and add-back therapy is there a perfect combination Br J Obstet Gynaecol 105 475-485... 

A laparoscopy is performed and the cysts drained. The patient is prescribed GnRh analogue plus add-back therapy. Two months later she is readmitted with left loin pain, hot, cold and dizzy symptoms. The impression is a flare-up of the endometriosis. The pain team prescribed morphine 2 hourly. Patient had radical operation subtotal abdominal hysterectomy and bilateral salpingo-oophorectomy. 

Freundl G, Godtke K, Gnoth C, Godehardt E, Kienle E. Steroidal add-back therapy in patients treated with GnRH agonists. Gynecol Obstet Invest 1998 45 Suppl 1 22-30 discussion 35. 

Nonsteroidal anti-inflammatory drugs ibuprofen, ketoprofen, naproxen sodium Alternative bromocriptine, danazol, oral contraceptives, gonadotropin releasing hormone agonist estrad iol/progesterone add-back therapy Migraines Caffeine restriction... 

Serotonin reuptake inhibitor (intermittent or continuous with increase in dose during luteal phase) Alternative danazol or gonadotropin-releasing hormone agonist for 2-3 cycles (if longer treatment, estradiol progesterone add-back therapy may be required)... 

Surgical treatment such as bilateral ovariectomy is controversial because it is irreversible and is associated with severe hormonal deficiency states unless there is add-back therapy. In addition, a tubal ligation ora partial hysterectomy is not effective for menstrual-related disorders. Clinicians usually reserve a complete hysterectomy as a last-resort treatment in severely affected patients who do not respond to standard therapies. 

Goserelin 3.6 mg SQ monthly Add-back therapy improves side effects and... 

The optimal time to initiate add-back therapy remains controversial. The cost of the regimen must be balanced against the potential benefit. Add-back therapy is not recommended for GnRH-a regimens of less than 3 months duration. Use of add-back therapy for GnRH-a regimens of 3 to 6 months duration is for the primary purpose of relief of vasomotor symptoms and improved adherence... 

Add-back therapy alleviates the vasomotor symptoms and bone density loss associated with GnRH-a. Controversy... 

Surrey ES. Add-back therapy and gonadotropin-releasing hormone agonists in the treatment of patients with endometriosis Can a consensus be reached Add-Back Consensus Working Group. Fertil Steril 1999 71 420-424. 

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