Treatment of Endometriosis in Adolescents

Adolescent endometriosis pain and Lupron

Key Points

Highlights:

Most women with endometriosis who were treated with Lupron plus add-back as adolescents would recommend the treatment to others despite side effects.

Importance:

The findings of this study provide critical information to women with endometriosis as well as doctors about the use of GnRHa plus add-back during adolescence. It also suggests that a combined add-back regimen might be better than the standard single add-back.

What's done here:

Researchers questioned 51 women who had participated in a clinical trial as adolescents assessing the effect of Lupron plus add back therapy. 

Key results:

• 96% of women who responded to the questionnaire reported having experienced side-effects during the clinical trial
• 80% of women noted the side effects that lasted more than six months after the end of the study.
• 45% of women considered their side effects to be irreversible. 
• Women considered Lupron plus add back to be the most effective hormonal medication to treat endometriosis pain.
• Women who were treated with two add-back reported more success than those who were treated with just one add-back.
• Two-third of women said they would recommend the treatment to others despite the side effects.

Limitations of the study:

• The side effects reported by patients may have been caused by a new treatment regimen after stopping Lupron plus add back therapy.
• The results were based on patient responses and could not be confirmed with physical exams and other diagnostic methods and therefore are subjective. 
• The response rate to the questionnaire was higher among women who participated in the clinical trial more recently so the results could be biassed towards recent use. 
• It is difficult to compare these findings with the effect of other hormone-altering medications as there is no long-term follow-up data available for these medications.
• The study focused specifically on patients who were treated as adolescents, and the findings might not be valid for adult women with endometriosis.

Lay Summary

Most women with endometriosis who have been treated with Lupron plus add back as adolescents felt the treatment was effective in reducing the pain caused by the condition, according to a study published in the Journal of Pediatric & Adolescent Gynecology. Moreover, most of them would recommend the treatment to others despite the side effects, the study found.

Lupron is a gonadotropin-releasing hormone agonist (GnRHa) that provides pain relief and reduces the size of endometriosis lesions. To investigate the tolerability and long-term side effects of this treatment plus two different add-back medications, norethindrone acetate, and conjugated equine estrogens, researchers at Boston Children's Hospital and Brigham and Women's Hospital in Boston, Massachusetts questioned 51 patients who had a surgically confirmed endometriosis diagnosis as adolescents.

All patients had participated in a clinical trial as adolescents assessing the effect of Lupron plus add-back treatment between 2008 and 2012. During the trial, all patients were given 11.25 mg of Lupron as an injection into their muscle every three months plus 5 mg of norethindrone acetate by mouth every day either with or without 0.625 mg of conjugated equine estrogens.

The researchers sent the patients a follow-up questionnaire in 2016 that collected information about the side effects of the treatment during and after the trial, any irreversible side effects, changes in pain, and their overall satisfaction with the procedure.  

Sixty-one percent of the patients responded to the questionnaire, and almost all of them (96 percent) said that they experienced side-effects such as hot flashes, weight gain, mood swings, and breast tenderness during treatment. Eighty percent of the patients reported they suffered long-terms sided effects, lasting more than six months after stopping the medication. Forty-five percent of the patients said that they had side effects like memory loss, insomnia, and hot flashes that never went away. 

However, in spite of these side effects, some of which were long-term or irreversible, patients rated the treatment as  “the most effective hormonal medication for treating endometriosis pain,” and two-thirds of them said they would recommend it to others. Patients receiving two add-back regimens reported more success in pain reduction compared to those who received the standard single add back.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/29551430