The dose of the GnRHa after laparoscopic surgery

Laparoscopic surgery is the routine practice to diagnose and to remove endometriosis. Which dose is preferable when GnRHa should be used?

Key Points

Highlight:

• This study compared the therapeutic effect of 1.88 mg and 3.75 mg gonadotrophin-releasing hormone agonist (GnRHa) in the treatment of endometriosis after laparoscopic surgery.

Importance:

• 1.88-mg GnRHa treatment after laparoscopic surgery can reduce peri-menopausal symptoms, improve bone loss, and achieve a good clinical effect in stage III–IV endometriosis patients.

What's done here:

• Fifty patients with stage III–IV endometriosis were randomized into two groups, one receiving 1.88 mg and the other 3.75 mg GnRHa (Leuprorelin).
• Side effects associated with GnRHa therapy including sex hormone level, symptoms of estrogen deficiency and lumbar vertebrae bone density were analyzed.

Data:

• Surgery combined with both doses of GnRHa relieved dysmenorrhea.
• Bone density was decreased in both groups.
• The symptoms of perimenopause were experienced by both groups.
• The follicle-stimulating hormone and luteinizing hormone were decreased in both groups, with no difference between the two groups.
• The higher dose has significantly reduced estradiol.

Limitations:

• The study consisted of a small number of patients.
• It is unclear whether GnRHa therapy after laparoscopic surgery really reduce or diminish endometriosis recurrence since the study did not follow the patients for a long term.

Lay Summary

Laparoscopic surgery is considered a routine way to diagnose and remove endometriosis. The primary concern with laparoscopic surgery is the recurrence of endometriosis because of incomplete lesion excision. Hence, the challenge is to decrease endometriosis recurrence rate.

Gonadotrophin-releasing hormone agonist (GnRHa) is a clinically available for treating endometriosis, however, the use after a certain period of time can suppress sex steroids, leading to reduction of bone mineral density, and an increase in symptoms of estrogen deficiency including hot flashes, and sexual related symptoms such as loss of libido and vaginal dryness.

The aim of this study by Tang et al. from Peking University Shenzhen Hospital, China, were to investigate the effect of 1.88 mg GnRHa and 3.75 mg GnRHa on grade III–IV endometriosis and to evaluate the optimal dose of GnRHa to prevent side-effects while maintaining treatment effectiveness.

The study outcomes show that post-surgery GnRHa (Leuprorelin) either the 3.75 mg or 1.88 mg, may relieve the degree of dysmenorrhea. With regard to side effects, both doses reduced bone density at 20 weeks after treatment, with higher dose resulted in increased degree of bone density loss. At 8 weeks after treatment, both groups had symptoms of perimenopause, although at 16 and 20 weeks these symptoms were improved in the half-dose group. The levels of follicle-stimulating hormone and luteinizing hormone were reduced in both groups with no significant difference between the two groups. In addition, the level of estradiol in the full-dose group was significantly reduced when compared to the half-dose group. Hence, 1.88 mg GnRHa treatment is preferable in stage III-IV endometriosis patients after laparoscopic surgery. 

Some limitations of the study include the small number of cohorts and due to the absence of a longitudinal analysis, unclarity of its effect on reduction of endometriosis reoccurrence.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/?term=28707810