nafarelin and Pain

Endometriosis is a common condition for which a number of treatments have been proposed. Medical treatments are based on the hormonal responsiveness of endometriosis implants. These therapies include progestins (with or without estrogens), androgens, and gonadotropin-releasing hormone (GnRH) analogs. Surgical treatments may include hysterectomy with oophorectomy or organ-sparing surgery involving ablation or resection of visible lesions of endometriosis and restoration of pelvic anatomy. There are no studies that directly compare the effectiveness or adverse effects of medical therapy and surgical therapy. Studies on medical therapy compare different treatments with placebo or with other active treatments. Hormone-based therapies for endometriosis show 80%-100% effectiveness in relief of pelvic pain over a 6-month course of therapy. Serious adverse outcomes after medical therapy are unusual. Studies on surgical therapy are largely anecdotal, with noncomparative reports on a variety of surgical methods. A few comparative surgical studies have been reported. Because of the noncomparative nature of many of the surgical studies, the use of combinations of surgical procedures and techniques in the reported studies, and the reporting of results from surgeons with an unusually high level of technical skill, the gynecological practitioner has little basis in the literature for assessing the optimum surgical approach. Surgical complications are believed to be underreported and may be related to how aggressive a surgical procedure is undertaken.

Topics: Androgens; Contraceptives, Oral; Danazol; Endometriosis; Estrogen Antagonists; Female; Gonadotropin-Releasing Hormone; Hormones; Humans; Hysterectomy; Laparoscopy; Leuprolide; Nafarelin; Ovariectomy; Pain; Pain Measurement; Progestins; Recurrence; Research Design; Treatment Outcome

To examine the impact of treating endometriosis with nafarelin or leuprolide acetate depot on patient quality of life (QOL) and subjective clinical measures.. A randomized, multicenter study was conducted on 192 women with endometriosis. Patients received nafarelin or leuprolide for six months and were followed for up to six months after treatment. QOL was defined by seven items, including symptom severity, daily activities, pain medication use and need for bed rest.. No significant differences were found at baseline between treatments for patients with mild, moderate or no endometriosis symptoms. Those with severe symptoms of endometriosis at baseline and taking nafarelin had a significantly greater improvement in QOL at the last posttreatment visit than those receiving leuprolide (P < .01). Nafarelin was associated with significantly fewer days with moderate or severe hot flashes than leuprolide during treatment (P < .05) and with significantly fewer moderate or severe hypoestrogenic symptoms overall at three months of treatment (P < .05). Additionally, poorer QOL was significantly associated with hypoestrogenic and endometriosis symptoms.. Treatment of endometriosis with nafarelin was associated with fewer days of moderate or severe hot flashes as compared to leuprolide and with greater improvement in QOL after treatment in patients with severe symptoms at baseline.

Topics: Adult; Analgesics; Bed Rest; Endometriosis; Female; Fertility Agents, Female; Hormones; Hot Flashes; Humans; Leuprolide; Middle Aged; Nafarelin; Pain; Quality of Life; Severity of Illness Index; Treatment Outcome

To assess the efficacy, safety, and effect on bone mineral density of a 3-month course of retreatment with intranasal nafarelin acetate for recurrent symptoms of endometriosis.. Multicenter, open-label, nonrandomized clinical trial.. Eleven hospital-based and private practices.. Thirty-six women with endometriosis symptoms recurring after 3 or 6 months of treatment with nafarelin.. Nasal nafarelin 200 micrograms twice daily for 3 months.. Assessments for dysmenorrhea, dyspareunia, pelvic pain, tenderness, and induration. Measurement of bone mineral density of the lumbar spine.. Improvements from admission to the end of retreatment were significant for dysmenorrhea, pelvic pain, tenderness, induration, and dyspareunia. Three months after retreatment ended, mean symptom scores for dysmenorrhea and pelvic tenderness, although worse than at the end of retreatment, were still significantly better than scores at admission. Mean bone mineral density 3 months after retreatment was 0.56% lower than before retreatment and 1.94% lower than before initial treatment.. Three-month nafarelin retreatment for recurrent endometriosis symptoms was effective and safe.

Topics: Administration, Intranasal; Adult; Bone Density; Dysmenorrhea; Endometriosis; Female; Hormones; Humans; Middle Aged; Nafarelin; Pain; Recurrence

As part of a large, multicenter trial, 82 patients with endometriosis were randomized to 6 months of treatment with either nafarelin or danazol. Among 73 patients who had subjective symptoms (dysmenorrhea, dyspareunia, or pelvic pain) at baseline, 94% of patients treated with nafarelin and 91% of those treated with danazol had improvement. Resolution of physical findings also was observed in similar percentages of patients in each treatment group. Long-term studies are needed to determine whether these two agents are associated with different cure rates or times to recurrence of disease.

Topics: Amenorrhea; Clinical Trials as Topic; Danazol; Endometriosis; Female; Gonadotropin-Releasing Hormone; Humans; Nafarelin; Pain

Topics: Administration, Intranasal; Breast; Female; Follow-Up Studies; Gonadotropin-Releasing Hormone; Humans; Nafarelin; Pain; Placebos