Tolerability considerations for gonadotropin-releasing hormone analogues for endometriosis. (1st September 2020)

• Record Type: Journal Article
• Authors: Della Corte, Luigi; Barra, Fabio; Mercorio, Antonio; Evangelisti, Giulio; Rapisarda, Agnese Maria Chiara; Ferrero, Simone; Bifulco, Giuseppe; Giampaolino, Pierluigi
• Is Part Of: Expert opinion on drug metabolism and toxicology. Volume 16:Number 9(2020)
• Page Start: 759
• Page End: 768
• Publication Date: 2020-09-01
• Subjects: Endometriosis -- hormonal therapy -- gonadotropin-releasing hormone analogs -- add-back therapy -- norethisterone acetate -- combined oral contraceptives -- bone mineral density -- vasomotor symptoms; Drugs -- Toxicology -- Periodicals; Drugs -- Metabolism -- Periodicals; 615.7
• DOI: 10.1080/17425255.2020.1789591
• Languages: English
• ISSNs: 1742-5255

Abstract

ABSTRACT: Introduction: The second-line treatment of endometriosis-related pain symptoms includes injectable depot formulations of gonadotropin-releasing hormone analogs (GnRH-as). These drugs improve the symptomatology by inducing a hypoestrogenic status and a consequent regression of endometriotic implants. However, GnRH-a may cause a not negligible rate of adverse events, in particular vasomotor symptoms and bone mineral density loss, that may limit patients' adherence and safety on long-term treatment. Several strategies have been suggested to improve the compliance to treatment. Areas covered: This narrative review aims to give an overview of the safety and tolerability of GnRH-a therapy and to present the different options of steroidal and non-steroidal add-back therapies in order to reduce the hypoestrogenic side effects. Expert opinion: Side effects of long term GnRH-a treatment are particularly relevant. Although it has been known the efficacy of GnRH-as for treating endometriosis-associated pain, the best schedules of therapy in terms of duration and dosages are still to be defined. The ideal treatment schedule of GnRH-a is still a matter of debate as to the optimal add-back combination.