goserelin and Dysmenorrhea

Endometriosis is a common gynaecological condition which affects many women of reproductive age worldwide and is a major cause of pain and infertility. The combined oral contraceptive pill (COCP) is widely used to treat pain occurring as a result of endometriosis, although the evidence for its efficacy is limited.. To determine the effectiveness, safety and cost-effectiveness of oral contraceptive preparations in the treatment of painful symptoms ascribed to the diagnosis of laparoscopically proven endometriosis.. We searched the following from inception to 19 October 2017: the Cochrane Gynaecology and Fertility Group Specialised Register of Controlled Trials, the Cochrane CENTRAL Register of Studies Online (CRSO), MEDLINE, Embase, PsycINFO, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the trial registers ClinicalTrials.gov and the World Health Organization Clinical Trials Registry Platform (WHO ICTRP). We also handsearched reference lists of relevant trials and systematic reviews retrieved by the search.. We included randomised controlled trials (RCT) of the use of COCPs in the treatment of women of reproductive age with symptoms ascribed to the diagnosis of endometriosis that had been made visually at a surgical procedure.. Two review authors independently assessed study quality and extracted data. One review author was an expert in the content matter. We contacted study authors for additional information. The primary outcome was self-reported pain (dysmenorrhoea) at the end of treatment.. Five trials (612 women) met the inclusion criteria. Only three trials (404 women) provided data that were suitable for analysis.Combined oral contraceptive pill versus placeboTwo trials compared COCP with a placebo. These studies were at high risk of bias. For GRADE outcomes (self-reported pain (dysmenorrhoea) at the end of treatment), the quality of the evidence very low. Evidence was downgraded for imprecision as it was based on a single, small trial and for the visual analogue scale data there were wide confidence intervals (CIs). There appeared to have been substantial involvement of the pharmaceutical company funding the trials.Treatment with the COCP was associated with an improvement in self-reported pain at the end of treatment as evidenced by a lower score on the Dysmenorrhoea verbal rating scale (scale 0 to 3) compared with placebo (mean difference (MD) -1.30 points, 95% CI -1.84 to -0.76; 1 RCT, 96 women; very low quality evidence), a lower score on the Dysmenorrhoea visual analogue scale (no details of scale) compared with placebo (MD -23.68 points, 95% CI -28.75 to -18.62, 2 RCTs, 327 women; very low quality evidence) and a reduction in menstrual pain from baseline to the end of treatment (MD 2.10 points, 95% CI 1.38 to 2.82; 1 RCT, 169 women; very low quality evidence).Combined oral contraceptive pill versus medical therapiesOne underpowered trial compared the COCP with another medical treatment (goserelin). The study was at high risk of bias; the trial was unblinded and there was insufficient detail to judge allocation concealment and randomisation. For GRADE outcomes (self-reported pain (dysmenorrhoea) at the end of treatment), the quality of the evidence ranged from low to very low.At the end of treatment, the women in the goserelin group were amenorrhoeic and therefore no comparisons could be made between the groups for the primary outcome. At six months' follow-up, there was no clear evidence of a difference between women treated with the COCP and women treated with goserelin for measures of dysmenorrhoea on a visual analogue scale (scale 1 to 10) (MD -0.10, 95% CI -1.28 to 1.08; 1 RCT, 50 women; very low quality evidence) or a verbal rating scale (scale 0 to 3) (MD -0.10, 95% CI -0.99 to 0.79; 1 RCT, 50 women; very low quality evidence). At six months' follow-up, there was no clear evidence of a difference between the COCP and goserelin groups for reporting complete absence of pain as measured by the visual analogue scale (risk ratio (. Based on the limited evidence from two trials at high risk of bias and limited data for the prespecified outcomes for this review, there is insufficient evidence to make a judgement on the effectiveness of the COCP compared with placebo and the findings cannot be generalised.Based on the limited evidence from one small trial that was at high risk of bias, there is insufficient evidence to make a judgement on the effectiveness of the COCP compared with other medical treatments. Only one comparison was possible, with the medical intervention being goserelin, and the findings cannot be generalised.Further research is needed to fully evaluate the role of COCPs in managing pain-related symptoms associated with endometriosis. There are other formulations of the combined hormonal contraception such as the transdermal patch, vaginal ring or combined injectable contraceptives which this review did not cover but should be considered in future updates.

Topics: Contraceptives, Oral; Dysmenorrhea; Endometriosis; Female; Goserelin; Humans; Pelvic Pain; Randomized Controlled Trials as Topic

To evaluate the clinical outcomes of gonadotropin-releasing hormone analog (GnRHa) combined with implantation of a levonorgestrel-releasing intrauterine system (LNG-IUS) in adenomyosis patients with significantly enlarged uteruses.. Twenty-one adenomyosis patients whose uterine volumes were greater in size than at 12 weeks' gestation were recruited for the study. Subcutaneous injection of GnRHa was administrated at an interval of 28 days for a total of 3-4 cycles when uterine length was determined to be less than 10 cm by ultrasound measurement. At 3, 6 and 12 months after LNG-IUS implantation, follow-up was performed to document the clinical values such as uterine volume, degree of dysmenorrhea and menstrual flow.. Twelve months after implantation, the menstrual flow was significantly lower than baseline values (53.8 ± 11.7 vs. 100, p = 0.03). The degree of dysmenorrhea (pain) was relieved 12 months after implantation (58.2 ± 11.5 vs. 93.7 ± 0.2, p = 0.005). Uterine volume was also below pre-GnRHa levels after implantation (276.6 ± 32.1 vs. 311.4 ± 32.3, p = 0.005). LNG-IUS was expelled in 3 patients, giving an expulsion rate of 14%. Side effects of GnRHa combined with LNG-IUS implantation were few.. The findings indicate that combined GnRHa and LNG-IUS treatment was efficacious in patients with enlarged adenomyosis.

Topics: Adenomyosis; Drug Delivery Systems; Dysmenorrhea; Female; Goserelin; Humans; Intrauterine Devices, Medicated; Levonorgestrel; Organ Size; Pain; Progestins; Uterus

To evaluate the efficacy of goserelin versus a low-dose cyclic oral contraceptive (OC) in improving pelvic pain in women with endometriosis and to compare recurrence of symptoms during follow-up.. Open-label, randomized trial.. University hospital endometriosis center.. Fifty-seven women with moderate or severe pelvic pain and laparoscopically diagnosed endometriosis.. Six-month treatment with goserelin depot (n = 29) or a low-dose cyclic OC (n = 28) followed by 6-month follow-up.. Variation in severity of symptoms during treatment and at the end of follow-up as shown by a linear analog scale and a verbal rating scale.. At 6 months of treatment, a significant reduction in deep dyspareunia was observed in both groups, with goserelin superior to the OC at linear analog scale assessment. Nonmenstrual pain was diminished on both scales without differences between treatments. Women taking the OC experienced a significant reduction in dysmenorrhea. At the end of follow-up, symptoms reappeared without differences in severity between the groups.. Low-dose cyclic OCs may be a valuable alternative for the treatment of dysmenorrhea and nonmenstrual pain associated with endometriosis. Symptoms recurred in most subjects 6 months after drug withdrawal.. Physicians at the University of Milan in Italy compared data on 29 endometrial patients who received 3.6 mg goserelin in a 28-day subcutaneous depot formulation for 6 months to treat nonmenstrual pelvic pain, dysmenorrhea, and pain during coitus (dyspareunia) with data on 28 other endometrial patients treated with a low-dose monophasic oral contraceptive (OC) (.02 mg ethinyl estradiol and 0.15 mg desogestrel) for 6 months. They followed the women for 6 months after treatment ended. The physicians wanted to determine the efficacy of goserelin, a gonadotropin-releasing hormone (GnRH) agonist, versus a low dose OC to relieve pelvic pain in patients with endometriosis and to compare pain recurrence after drug withdrawal. (GnRH agonists are current medical treatments for pelvic pain, but they have several side effects and are expensive; and therefore their use is restricted.) At the end of treatment, both goserelin and the low-dose OC significantly reduced dyspareunia (p .01), especially goserelin according to the linear analog scale (pain symptom score, 1.8 points lower). Both treatments improved nonmenstrual pain equally at the end of treatment (p .01). The low-dose OC reduced dysmenorrhea greatly at the end of treatment (p .01). The researchers could not evaluate dysmenorrhea in goserelin cases, since these patients experienced amenorrhea. The only persistent significant reduction at the end of follow-up occurred with dyspareunia in goserelin patients (p .05). In the other patients, pelvic pain returned to baseline levels 6 months after treatment ended. The severity of pelvic pain did not differ between groups 6 months after follow-up. These results suggested that low-dose OCs may be an effective alternative treatment for dysmenorrhea and nonmenstrual pelvic pain linked to endometriosis.

Topics: Adolescent; Adult; Contraceptives, Oral; Dysmenorrhea; Dyspareunia; Endometriosis; Female; Follow-Up Studies; Goserelin; Humans; Pain; Recurrence

This prospective cohort study aimed to compare the clinical efficacy and safety of goserelin 10.8 mg administered trimonthly with goserelin 3.6 mg administered monthly in premenopausal females with symptomatic adenomyosis.. We recruited 139 premenopausal females with adenomyosis who complained of dysmenorrhea and/or menorrhagia. The first group (. Ultimately, 130 patients completed the study, including 68 and 62 patients in the goserelin 10.8 mg (. The clinical efficacy of trimonthly administration of goserelin 10.8 mg was equivalent to monthly 3.6 mg dosing and was non-inferior regarding safety and tolerability. Hence, it can be a more cost-effective and convenient alternative treatment option in premenopausal females with symptomatic adenomyosis.. ChiCTR2200059548.

Topics: Adenomyosis; Dysmenorrhea; East Asian People; Female; Goserelin; Humans; Prospective Studies; Treatment Outcome

To study the efficacy and safety of the dienogest and the gonadotropin-releasing hormone agonist (GnRH-a) in symptomatic females with uterine adenomyosis.. A total of 127 patients with adenomyosis with a chief complaint of dysmenorrhea were recruited. The first group received 2 mg of dienogest (DNG) daily, whereas the second group received goserelin acetate (GS) (3.6 mg/4 weeks) for 12 weeks. Outpatient follow-up was undertaken after 12 weeks.. Among 127 women, 56/63 (88.9%) patients completed the treatment in the DNG group, whereas 62/64 (96.9%) patients completed the treatment in the GS group. A significant decrease in dysmenorrhea symptoms as measured by the visual analog scale (VAS) and Carcinoma antigen125 (CA125) after 12 weeks of treatment was observed in both groups (. Dienogest effectively alleviates the symptoms of dysmenorrhea in patients with adenomyosis, but it cannot improve the anemia or reduce the size of the uterus. GnRH-a is more effective in improving anemia and reducing the uterine volume in patients with adenomyosis.

Topics: Adenomyosis; Cohort Studies; Dysmenorrhea; Female; Gonadotropin-Releasing Hormone; Goserelin; Humans; Nandrolone

The aim of our study was to assess the long-term efficacy of conservative surgery combined with gonadotropin-releasing hormone agonist therapy for uterine adenomyoma.. We carried out an uncontrolled descriptive study of 285 women who had symptomatic uterine adenomyoma. A total of 186 women with pathologically proven adenomyoma underwent ultramini-laparoscopic adenomyomectomy and a 6-month course of goserelin acetate treatment, and were evaluated semi-annually during a follow-up period of at least 3 years.. Patient scores for dysmenorrhea using a self-reported six-point verbal numeric rating scale significantly declined compared with the baseline assessment, from 3.84 ± 0.65 to 0.33 ± 0.57, 0.52 ± 0.86, and 0.88 ± 1.29 at the end of the 1-, 2-, and 3-year follow-up visits, respectively (p < 0.001). Similar reductions were observed for analgesic usage scores. Menorrhagia scores significantly decreased compared with the baseline assessment, from 3.45 ± 1.46 to 0.42 ± 0.59, 0.65 ± 0.83, and 1.1 ± 1.34 at the end of the 1-, 2-, and 3-year follow-up visits, respectively (p < 0.001).. Combination therapy for adenomyoma provides an effective treatment option for long-term symptom control and uterine preservation in severely symptomatic women for whom previous long-term drug therapy has failed or proven to be intolerable.

Topics: Adenomyoma; Adolescent; Adult; Antineoplastic Agents, Hormonal; Chemotherapy, Adjuvant; Drug Administration Schedule; Dysmenorrhea; Female; Follow-Up Studies; Goserelin; Humans; Kaplan-Meier Estimate; Laparoscopy; Menorrhagia; Middle Aged; Severity of Illness Index; Treatment Outcome; Uterine Neoplasms; Uterus; Young Adult

To evaluate the short-term effect of leuprorelin acetate microspheres in preventing recurrence of ovarian endometrioma after conservative surgery.. From January 2011 to September 2011, 190 ovarian endometrioma patients undergoing conservative laparoscopic surgery at Affiliated Obstetrics and Gynecology Hospital Affiliated to Fudan University were enrolled in this retrospective study. Among 184 patients were followed up, the range of following up were 12 to 21 months. 116 cases presented dysmenorrheal. Based on postoperative treatment, they were classified into 124 cases treated by domestic gonadotropin releasing hormone agonist(GnRH-a) post-operatively for 3-6 months and 60 cases without postoperative treatment. Among all, 63 patients were treated with, that was leuprorelin acetate microspheres for injection (Beiyi, 3.75 mg, q28 d), 61 patients were treated with imported GnRH-a post-operatively for 3-6 months, that were either Zoladex(3.6 mg, q28 d), Dophereline(3.75 mg, q28 d) or Enatone (3.75 mg, q28 d). The recurrence and pain improvement were compared among those groups.. (1) The total rate of cyst recurrence was 12.5% (23/184) while the average recurrent time was (13.7 ± 2.6) months (2-21 months). The cyst recurrence rate was significantly lower in patients treated with GnRH-a post-operatively than those who didn't take medications [21.7% (13/60) versus 8.1% (10/24), P < 0.05]. However, there was no significant difference between domestic GnRH-a group and the imported one [7.9% (5/63) versus 8.2% (5/61), P > 0.05]. (2) After conservative surgery, symptoms were found to be relieved in 87.1% (101/116) patients among 116 patients complaining of dysmenorrheal pre-operatively and the pain recurrence rate was 12.9% (13/101). However, there was no significant difference in either symptom relief rate or pain recurrence rate among different groups. The symptom relief rate were 87% (33/38), 86% (37/43) and 89% (31/35) while the pain recurrence rate were 12% (4/33), 14% (5/37) and 13% (4/31) respectively in none, imported GnRH-a group and domestic GnRH-a group.. Leuprorelin acetate microspheres could be effective in preventing recurrence of ovarian endometrioma, but not in symptom relieving after conservative surgery in short term. The effect of domestic and imported GnRH-a was similar.

Topics: Adult; Dysmenorrhea; Endometriosis; Female; Follow-Up Studies; Gonadotropin-Releasing Hormone; Goserelin; Humans; Laparoscopy; Leuprolide; Middle Aged; Ovarian Diseases; Retrospective Studies; Secondary Prevention; Treatment Outcome; Young Adult

This paper reports the long-term follow-up (62-83 months) of women with unexplained subfertility secondary to severe adenomyosis treated with the combination of conservative surgery and gonadotropin releasing hormone agonist (GnRH agonist) therapy.. A retrospective study included nine patients with a history of > 3 years of unexplained infertility who had extensive uterine adenomyosis. These nine couples were diagnosed with unexplained infertility after excluding other possible causes, such as the male factor, ovulation disorders, structural abnormality, and infections. All were essentially normal except for presumed uterine adenomyosis and elevated serum levels of CA125. All underwent a careful excision of the adenomyosis tissue using a microsurgical technique, and then a six-month course of GnRH agonist therapy. The outcome evaluations included serum level of CA125, degree of dysmenorrhea, and rate of spontaneous pregnancy.. Postoperative follow-up showed that the severity of dysmenorrhea was significantly improved. The improvement scale was positively correlated with a decline in the serum level of CA125. A postoperative serum CA125 decreased to less than 10.00 IU/mL predicted well the spontaneous pregnancy rate, especially during the therapy. In the end, only two women became pregnant and finally delivered viable babies in this study.. Although the combination of careful conservative surgery and GnRH agonist therapy might provide some benefits in patients with unexplained infertility and presumed severe adenomyosis, two-thirds of the patients still failed to become pregnant. The postoperative serum level of CA125 could predict the future pregnancy rate.

Topics: Adenomyosis; Adult; Antineoplastic Agents, Hormonal; CA-125 Antigen; Dysmenorrhea; Female; Fertility Agents, Female; Follow-Up Studies; Gonadotropin-Releasing Hormone; Goserelin; Humans; Infertility, Female; Leuprolide; Microsurgery; Predictive Value of Tests; Pregnancy; Pregnancy Rate; Retrospective Studies; Time Factors

To evaluate follicle loss and its associated factors during laparoscopic cystectomy for ovarian endometrioma.. Between October 2008 and December 2009, 140 patients with ovarian cysts undergoing laparoscopic cystectomy at Peking Union Medical Hospital were enrolled: 74 had ovarian endometrioma with no preoperative hormonal therapy (group A), 40 had ovarian endometrioma pretreated with GnRHa (group B), and 26 had non-endometriotic cysts (group C). Pre-, peri- , and postoperative clinical data were collected, and cyst specimens were evaluated histologically.. The number of capsules showing follicles and the mean number of follicles per capsule were lower in group C than in group A or B (P<0.05). Fewer type IIC than type IIB endometriomas showed follicles (P<0.05). The number of follicles per cyst was related negatively to disease duration but positively to pain severity. Women in group A with unilateral endometrioma had a lower mean dysmenorrhea score after the surgery (P<0.05), but no change in basal follicle-stimulating hormone (FSH).. The type of cyst, disease duration, and severity of dysmenorrhea were associated with ovarian follicle loss during laparoscopic excision of endometrioma. Laparoscopic unilateral cystectomy for endometrioma was effective in relieving pain but had little effect on serum FSH, which might reflect the remaining ovarian reserve.

Topics: Adolescent; Adult; China; Dysmenorrhea; Endometriosis; Female; Follicle Stimulating Hormone; Follow-Up Studies; Goserelin; Humans; Laparoscopy; Middle Aged; Ovarian Cysts; Ovarian Follicle; Pain; Retrospective Studies; Severity of Illness Index; Time Factors; Young Adult

Topics: Abdominal Pain; Danazol; Diagnosis, Differential; Dysmenorrhea; Endometriosis; Estrogen Antagonists; Female; Gonadotropin-Releasing Hormone; Goserelin; Humans; Hysterectomy; Laparoscopy; Leuprolide; Menorrhagia; Nafarelin; Nursing Assessment; Physical Examination; Progesterone; Severity of Illness Index

Topics: Adult; Dysmenorrhea; Female; Goserelin; Humans; Laparoscopes; Laparoscopy; Pain; Surgical Staplers; Ultrasonography; Uterus