Risks and benefits of long-term use of GnRH analogues and add-back therapy in women with endometriosis
DOI:
https://doi.org/10.11606/issn.2176-7262.rmrp.2025.222864Keywords:
Endometriosis, Gonadotropin-releasing hormone, Hormone replacement therapy, Pelvic PainAbstract
Endometriosis is a highly prevalent disease that has several clinical repercussions, such as pain and infertility. In the management of the disease, combined oral contraceptives, intrauterine systems, anti-inflammatories, surgeries, and also GnRH analogues can be used. However, the current recommendation is that the use of GnRH analogues be for a period of up to six months. Objective: Analyze the risks and benefits of using GnRH analogues associated with add-back therapy (hormonal therapy with estrogens and progestins) for a period of more than six months in patients with endometriosis. Methods: A systematic review was carried out searching for articles in the PUBMED, Scopus, and Web of Science databases, using the descriptors “Gonadotropin-Releasing Hormone”, “GnRH”, “Endometriosis” and “Hormone Replacement Therapy”. Results: Eight studies were selected, which used GnRH analogues (leuprolide or goserelin or triptorelin) for at least 12 months, associated with add-back therapy (tibolone or norethindrone and estrogens or promegestone and estradiol). The average age of the participants ranged from 17.9 to 37.2 years. Pain control was observed in most studies (six), and no significant bone loss was demonstrated with the therapy. Conclusion: The studies suggest the safety of prolonged use of GnRH analogues, despite the bone mass loss.
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