Treatment of endometriosis with goserelin depot, a long-acting gonadotropin-releasing hormone agonist analog: endocrine and clinical results

Endometriosis is a common condition for which a number of treatments have been proposed. Medical treatments are based on the hormonal responsiveness of endometriosis implants. These therapies include progestins (with or without estrogens), androgens, and gonadotropin-releasing hormone (GnRH) analogs. Surgical treatments may include hysterectomy with oophorectomy or organ-sparing surgery involving ablation or resection of visible lesions of endometriosis and restoration of pelvic anatomy. There are no studies that directly compare the effectiveness or adverse effects of medical therapy and surgical therapy. Studies on medical therapy compare different treatments with placebo or with other active treatments. Hormone-based therapies for endometriosis show 80%-100% effectiveness in relief of pelvic pain over a 6-month course of therapy. Serious adverse outcomes after medical therapy are unusual. Studies on surgical therapy are largely anecdotal, with noncomparative reports on a variety of surgical methods. A few comparative surgical studies have been reported. Because of the noncomparative nature of many of the surgical studies, the use of combinations of surgical procedures and techniques in the reported studies, and the reporting of results from surgeons with an unusually high level of technical skill, the gynecological practitioner has little basis in the literature for assessing the optimum surgical approach. Surgical complications are believed to be underreported and may be related to how aggressive a surgical procedure is undertaken.

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“…45 Pain was absent in 55% and was mild in an additional 24% of these women 6 months after the medication had been completed.…”

Section: Danazolmentioning

confidence: 93%

Medical and Surgical Therapies for Pain Associated with Endometriosis

Winkel

Scialli

2001

Journal of Women's Health & Gender-Based Medicine

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“…Ectopic endometrium in patients with endometriosis has also been reported to be estrogen/progesterone-dependent [39]. Suppressing the production of ovarian steroid hor mones has been shown to inhibit the development of endometriosis [40],…”

Section: Endometriosismentioning

confidence: 99%

Apoptosis in Human Endometrial and Endometriotic Tissues

Suganuma

Harada²,

Furuhashi³

et al. 1997

Horm Res

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Apoptosis has recently been proposed to represent programmed cell death. Several investigations have revealed that uterine endometrium in mammals can be regulated by apoptosis. However, apoptosis may be less likely to occur in human eutopic endometrium. On the other hand, immunoreactivity of Bcl-2 that may serve a regulatory function in protecting from undergoing apoptosis was observed in uterine endometrial glandular cells in the proliferative phase through to the early secretory phase. In endometriotic tissues, although apoptosis was detected in all the samples from ovarian endometriosis, it was indicated in only a few tissues from adenomyosis. Bcl-2 was negative in almost all samples from ovarian endometriosis, whereas it was positive in all adenomyotic tissues from cases in the proliferative phase, but in none of tissues from cases in the secretory phase. Thus, ovarian endometriosis can be discriminated from adenomyosis based on the existence of apoptosis though both represent a type of ectopic endometrial tissue, and the pathogenesis or condition of the cells may be different between ovarian endometriosis and adenomyosis.

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“…The median durations of the disease symptoms were 1.5 years (range 0.1-16) in the nafarelin 200 pg group, 0.8 years (range 0.1-10) in the nafarelin 400 pg group and 0.5 years (range 0. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] in the nafarelin 200 pg plus norethisterone 1.2 mg group. There were no significant differences between groups concerning symptom scores or pelvic examination scores.…”

Section: Resultsmentioning

confidence: 99%

A double-blind randomized study of the treatment of endometriosis with nafarelin or nafarelin plus norethisterone

Bergqvist

Jacobson

Harris³

1997

Gynecological Endocrinology

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The objective of this study was to compare the efficacy of nafarelin 200 micrograms (Group A), nafarelin 400 micrograms (Group B) and the combination of nafarelin 200 micrograms and norethisterone 1.2 mg (Group C) daily, in treating symptoms of endometriosis, American Fertility Society score and adverse events during 6 months of treatment. A prospective, randomized, double-blind parallel group study was performed in two centers and 49 women with endometriosis diagnosed laparoscopically were included. The patients were seen monthly for physical examination and records were taken for bleeding pattern, symptom score and adverse events. A control laparoscopy was performed at the end of 6 months of treatment. All patients were followed 6 months after treatment. At 3 and 6 months the pelvic examination total score had decreased significantly in all three groups. The total endometriosis score was significantly reduced in Groups B and C. After 2 months the total symptom score showed a significant decrease in Groups B and C. The frequency of hot flushes during the first month of treatment was lowest in Group C, but during the rest of treatment there were no differences between the groups. Best bleeding control was obtained in Group C. We conclude that nafarelin 200 micrograms daily has as good an effect on endometriosis symptoms as nafarelin 400 micrograms daily, and the addition of norethisterone 1.2 mg results in fewer hot flushes and better bleeding control.

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Treatment of endometriosis with goserelin depot, a long-acting gonadotropin-releasing hormone agonist analog: endocrine and clinical results

Cited by 34 publications

References 18 publications

Medical and Surgical Therapies for Pain Associated with Endometriosis

Medical and Surgical Therapies for Pain Associated with Endometriosis

Apoptosis in Human Endometrial and Endometriotic Tissues

A double-blind randomized study of the treatment of endometriosis with nafarelin or nafarelin plus norethisterone

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