GONADOTROPIN-RELEASING-HORMONE AGONIST PLUS ESTROGEN-PROGESTIN ADD-BACK THERAPY FOR ENDOMETRIOSIS-RELATED PELVIC PAIN

Objective: To evaluate the safety and efficacy of leuprolide acetate d epot (LA, Lupron; TAP Pharmaceuticals, Deerfield, IL) plus daily conju gated equine estrogens (Es, Premarin; Wyeth-Ayerst Laboratories, Phila delphia, PA), and medroxyprogesterone acetate (MPA, Provera; The Upjoh n Company, Kalamazoo, MI) ''add-back'' treatment of endometriosis-asso ciated pelvic pain. Design: Retrospective case series. Setting: Tertia ry care, academic medical center. Patients: Eight patients with modera te to severe pelvic pain and laparoscopically documented endometriosis . Intervention: Leuprolide acetate depot 3.75 mg IM every 4 weeks for 24 months. Oral conjugated equine Es 0.625 mg/d plus MPA 2.5 mg/d were also taken from treatment months 3 through 24. Results: Six women com pleted the 2-year study. Mean revised endometriosis scores for implant s, adhesions, and total values were significantly reduced at the concl usion of treatment from pretreatment scores. Self-reported pelvic pain scores were significantly lower at treatment months 3, 6, 12, 18, 24, and 6 months after therapy than pretreatment scores. Dual X-ray absor ptiometry bone density measurements of the lumbar spine did not change significantly during the 24-month treatment period. The proportion of women experiencing hot flushes was significantly reduced after E-prog estin add-back treatment from the proportion at treatment month 3. Con clusion: Treatment with LA depot plus conjugated equine Es and MPA for 2 years was a safe and effective therapy for women with endometriosis and pelvic pain in this small retrospective study.