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| IJCEM Copyright © 2008-All rights reserved. Published by e-Century Publishing Corporation, Madison, WI 53711 |
Int J Clin Exp Med 2013;6(7):583-588
Original Article
The incidence and characteristics of uterine bleeding during postoperative GnRH
agonist treatment combined with estrogen-progestogen add-back therapy in
endometriosis patients of reproductive age
Yi Han, Shi-En Zou, Qi-Qi Long, Shao-Fen Zhang
Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China; Department of Obstetrics and
Gynecology, BenQ Medical Center, Nanjing, Jiangsu, China
Received June 12, 2013; Accepted June 27, 2013; Epub August 1, 2013; Published August 15, 2013
Abstract: To evaluate the incidence and characteristics of uterine bleeding during postoperative gonadotropin-releasing hormone
agonist (GnRHa) treatment combined with the lowest effective dose of estrogen-progestogen add-back therapy in Chinese women of
reproductive age with endometriosis. Seventy Chinese women aged 18 to 50 years with stage III or IV endometriosis and treated with
postoperative GnRHa after conservative surgery for endometriosis were eligible for this study. Patients were randomly divided into two
equal groups, G and A. Group G (n = 35) received three 28-day cycles of postoperative GnRHa treatment by subcutaneous injection
(goserelin, 3.6 mg). Group A (n = 35) received the same GnRHa treatment in addition to daily estradiol valerate (0.5 mg) and
dydrogesterone (5 mg) add-back therapy. Serum E2 and FSH levels were assessed at the end of each treatment cycle, as well as
incidence and patterns of uterine bleeding. After the last GnRHa treatment cycle, endometrial thickness was evaluated by
ultrasonography and the recovery of menstruation was recorded. Uterine bleeding incidence was above 90% in both groups during the
first treatment cycle (group G: 90.6%; group A: 93.8%), but decreased markedly in the second treatment cycle (group G: 15.6%; group A:
21.9%), and continued to decline until the end of the third treatment cycle (group G: 6.3%; group A: 12.5%). For each cycle, the incidence
of uterine bleeding in group A was slightly but not statistically higher. Irregular spotting was the most common uterine bleeding pattern
observed in each of the three treatment cycle. The addition of estrogen and progestogen therapy to a postoperative GnRHa regimen
does not lead to an increase in the duration or amount of treatment-induced uterine bleeding. (IJCEM1306010).
Keywords: Endometriosis, GnRHa, estrogen, progestogen, add-back therapy, uterine bleeding
Address correspondence to: Dr. Shao-Fen Zhang. Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan
University, Shanghai, No. 128, Road Shenyang, District Yangpu, China. Phone: +86 13501831796; Fax: +86 21 63455090; E-mail:
zhangshaofen@163.com
Original Article
The incidence and characteristics of uterine bleeding during postoperative GnRH
agonist treatment combined with estrogen-progestogen add-back therapy in
endometriosis patients of reproductive age
Yi Han, Shi-En Zou, Qi-Qi Long, Shao-Fen Zhang
Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China; Department of Obstetrics and
Gynecology, BenQ Medical Center, Nanjing, Jiangsu, China
Received June 12, 2013; Accepted June 27, 2013; Epub August 1, 2013; Published August 15, 2013
Abstract: To evaluate the incidence and characteristics of uterine bleeding during postoperative gonadotropin-releasing hormone
agonist (GnRHa) treatment combined with the lowest effective dose of estrogen-progestogen add-back therapy in Chinese women of
reproductive age with endometriosis. Seventy Chinese women aged 18 to 50 years with stage III or IV endometriosis and treated with
postoperative GnRHa after conservative surgery for endometriosis were eligible for this study. Patients were randomly divided into two
equal groups, G and A. Group G (n = 35) received three 28-day cycles of postoperative GnRHa treatment by subcutaneous injection
(goserelin, 3.6 mg). Group A (n = 35) received the same GnRHa treatment in addition to daily estradiol valerate (0.5 mg) and
dydrogesterone (5 mg) add-back therapy. Serum E2 and FSH levels were assessed at the end of each treatment cycle, as well as
incidence and patterns of uterine bleeding. After the last GnRHa treatment cycle, endometrial thickness was evaluated by
ultrasonography and the recovery of menstruation was recorded. Uterine bleeding incidence was above 90% in both groups during the
first treatment cycle (group G: 90.6%; group A: 93.8%), but decreased markedly in the second treatment cycle (group G: 15.6%; group A:
21.9%), and continued to decline until the end of the third treatment cycle (group G: 6.3%; group A: 12.5%). For each cycle, the incidence
of uterine bleeding in group A was slightly but not statistically higher. Irregular spotting was the most common uterine bleeding pattern
observed in each of the three treatment cycle. The addition of estrogen and progestogen therapy to a postoperative GnRHa regimen
does not lead to an increase in the duration or amount of treatment-induced uterine bleeding. (IJCEM1306010).
Keywords: Endometriosis, GnRHa, estrogen, progestogen, add-back therapy, uterine bleeding
Address correspondence to: Dr. Shao-Fen Zhang. Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan
University, Shanghai, No. 128, Road Shenyang, District Yangpu, China. Phone: +86 13501831796; Fax: +86 21 63455090; E-mail:
zhangshaofen@163.com
