Effects of Kuntai capsule on GnRH-a-induced perimenopause symptoms:a prospective randomized controlled study / 中国实用妇科与产科杂志

OBJECTIVE: To evaluate the effect of Kuntai capsule on the gonadotrophin releasing hormone agonist(GnRH-a)-induced perimenopaus symptoms and the sex hormone levels.METHODS: A total of 99 patients with uterine fibroids,adenomyosis or moderate to severe endometriosis who needed the treatment of GnRH-a at Sun Yat-sen Memorial Hospital of Sun Yat-sen University from June 2015 to March 2016 were collected and randomly divided into research group(Kuntai capsule)and control group(Tibolone). GnRH-a was injected once every 28 days and first injection of GnRH-a was administered on the 2 nd to 4 th day of menstrual period or retraction bleeding after surgery.Kuntai capsule or Tibolone was orally taken beginning from the first GnRH-a injection,and the co-administration of Caltrate D-600 and alfacalcidol was given in both groups.The Kupperman scores,sex hormone levels including folliclestimulating hormone(FSH)and estrogen(E_2),and adverse events were recorded.RESULTS: Kuntai capsule kept the perimenopause symptoms at mild level with the slow increase of Kupperman scores,whose effect was significantly superior to Tibolone(P<0.05)after 8 weeks of treatment,especially in paresthesia,nervousness,and formication.The FSH and E_2 levels in both Kuntai and Tibolone groups were obviously decreased when compared with the pre-treatment(P<0.05),and these hormone levels in Kuntai group were comparable to those in Tibolone group.No adverse events occurred in either group. CONCLUSION: In the short-term treatment of GnRH-a,Kuntai capsule exhibits significant alleviating effects on perimenopause symptoms caused by GnRH-a with high safety and few adverse reactions.

Effects of different add-back regimens on hypoestrogenic problems by postoperative gonadotropin-releasing hormone agonist treatment in endometriosis

OBJECTIVE: To compare the efficacy of different add-back regimens on hypoestrogenic symptoms during postoperative gonadotropin-releasing hormone (GnRH) agonist treatment in endometriosis patients. METHODS: This prospective cohort study included reproductive-aged women who underwent conservative laparoscopic surgery for ovarian endometriosis and received add-back therapy during a 6-month course of GnRH agonist therapy after surgery. Participants received one of four different add-back regimens: 1 mg of estradiol valerate, 2.5 mg of tibolone, or a combination of 1 mg of estradiol and 2 mg of drospirenone or 0.5 mg of norethisterone acetate. Changes in quality of life, hypoestrogenic symptoms, and bone mineral density were compared according to add-back regimens. RESULTS: A total of 57 participants completed a 6-month course of GnRH agonist and add-back therapy. All components of quality of life did not differ across groups. However, within the same treatment group, social relationship factors decreased significantly with estradiol valerate and tibolone alone, and environmental factors decreased significantly with estradiol valerate alone. Menopausal Rating Scale score did not change significantly, but the incidence of hot flushes significantly decreased with a combination of estradiol and norethisterone acetate. Bone mineral densities at the lumbar spine declined significantly after treatment in all groups except with a combination of estradiol and norethisterone acetate. CONCLUSION: This preliminary study suggests that an add-back regimen containing estradiol valerate and norethisterone acetate may have better efficacy in terms of quality of life, hypoestrogenism-associated symptoms, and bone mineral density.

Clinical efficacy of laparoscopy combined with gonadotropin-releasing hormone agonist in treatment of endometriosis / 中国生化药物杂志

Objective To observe clinical efficacy of laparoscopy combined with gonadotropin-releasing hormone agonist (GnRH-a ) in the treatment of endometriosis (EMs).Methods 158 patients who underwent laparoscopic surgery and were diagnosed endometriosis in our hospital during Sep.2010 to Dec.2010 were chosen and divided into three groups:control group were treated with pure laparoscopic surgery,group A were treated with laparoscopic surgery and follow-up GnRH-a medication,and group B were treated with laparoscopic surgery,follow-up GnTH-a medication and add-back therapy.The total effective rates,recurrence rates,the changes of hormone levels before and after the treatment and adverse reaction rates after treatment were compared and analyzed to evaluate the efficacy of different treatments.Results The total effective rates of group A and group B (84.6%,86.2%) were significantly higher than that of control group (58.3%),and the difference was statistically significant (P=0.032,P=0.032).The recurrence rates of group A and group B (15.4%,13.8%)were significantly reduced compared with that of control group (41.6%)(P=0.012,P=0.012).The hormone levels decreased dramatically after treatment in three groups.The adverse reaction rate of group B was apparently reduced compared with that of group A,and the difference was statistically significant (P=0.001 ).Conclusion Laparoscopy combined with GnRH-a medication was a safe and effective treatment for endometriosis.The application of GnRH-a after laparoscopy can significantly increase the total effective rate of the operation and reduce the postoperative recurrence rate.For the patients who need to take long-term GnRH-a treatment,add-back therapy need to be given to decrease its adverse reaction and recurrence rate,or to delay its recurrence,thus could improve patients' living qualities significantly.

The Effect of Progestogen Add-back Therapy on Skeletal Status During GnRH Agonist Therapy for Endometriosis / 대한산부인과학회잡지

OBJECTIVE: GnRH agonist used in the medical treatment of endometriosis, induces accelerated bone loss, which leads to osteoporosis. This study was performed to investigate the possibilities of prevention of bone loss by progestogen add-back therapy in GnRH agonist treatment. METHODS: Thirty patients, who were diagnosed as endometriosis from Apr 1996 to Jun 2001, were divided into GnRH agonist treatment group and progestogen add-back therapy group. The changes of lumbar spine and femur BMD were checked from the onset of treatment to 6 months later, and the changes of bone markers (serum osteocalcin, urine deoxypyridinoline) from the onset of treatment, to 3 months later, to 6 months later, respectively. RESULTS: In GnRH agonist group, the BMDs were decreased by 5.56%, 3.85%, 6.10% and 5.19% in lumbar spine, femur neck, ward triangle, and femur trochanter respectively. All of these changes were significant compared with basal BMDs at each sites. Basal serum osteocalcin level of 5.34+/-2.37 ng/ml was significantly and continuously increased to 8.87+/-3.06 ng/ml and 11.87+/-3.15 ng/ml at 3rd and 6th month of treatment respectively. Urinary deoxypyridinoline level was increased from basal 7.07+/-2.48 ng/ml to 9.56+/-3.13 ng/ml at 3rd month and 9.87+/-2.18 ng/ml respectively. The significant change was noted from 3rd month of treatment with no change between 3rd and 6th month of treatment. In MPA add-back therapy group, the BMDs after treatment were significantly decreased by 5.39% and 4.30% only in lumbar spine and ward triangle of femur compared with pretreatment basal BMD levels. But there was no significant change at femur neck and trochanter. Serum osteocalcin level was significantly increased from basal 8.02+/-3.25 ng/ml to 11.05+/-4.02 ng/ml at 6th month of treatment, while there was no change at 3rd month of treatment. Meanwhile urinary deoxypyridinoline level was not changed during treatment. CONCLUSION: Although the decrease of BMD and the increase of bone turnover rate are induced during GnRH agonist therapy for endometriosis, progestogen add-back therapy could prevent these changes to some degree.