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- used in treatment of endometriosis since early 1980s
- induce a reversible pseudomenopause
- bind to pituitary GnRH receptors and result in a stimulation of follicle-stimulating
hormone (FSH) and luteinising hormone release; GnRH analogues have much longer
half-life than natural GnRH and therefore the pituitary is exposed to continuous
GnRH stimulation resulting in a down regulation of the pituitary and consequent
reduction of FSH and LH levels. Oestrogen levels equivalent to postmenopausal
levels are achieved within about 3 weeks of initiation of therapy
- side effects:
- oestrogen deficiency related e.g. vaginal dryness, hot flushes, reduction
of libido, bone loss
- duration of GnRH analogue treatment is limited by side effects, especially
bone loss (1); addback therapy is used to help prevent or reduce bone loss
secondary to GnRH analogue therapy. Various addback therapies have been
tried including progestogens, tibolone, bisphosphonates and combined oestrogen/progestogen.
The addback therapy should not negate the treatment effect of the GnRH analogue
on the endometriosis
- 1) Johansen JS et al (1988). The effect of GnRH agonist on bone metabolism.
J Clin Endocrinol Metab, 67, 701-6.
Last reviewed 01/2018