Riscos e Benefícios do Uso a Longo Prazo de Análogos do Gnrh Eterapia Add Back em Mulheres com Endometriose

Abstract

Endometriosis, which is characterized by endometrial tissue outside the uterine cavity, is a highly prevalent disease that has several clinical repercussions such as pain and infertility. In the management of the disease, combined oral contraceptives, intrauterine system, anti-inflammatories, surgeries and also GnRH analogues can be used. However, the current recommendation is that the use of GnRH analogues be for a period of up to six months. Objective: analyze the risks and benefits of using GnRH analogues associated with add back therapy (hormonal therapy with estrogens and progestins) for a period of more than six months in patients with endometriosis. Methods: A systematic review was carried out searching for articles in the PUBMED, Scopus and Web of Science databases, using the descriptors “Gonadotropin-Releasing Hormone”, “GnRH”, “Endometriosis” and “Hormone Replacement Therapy”. Results: Eight studies were selected, which used GnRH analogues (leuprolide or goserelin or triptorelin) for at least 12 months, associated with add back therapy (tibolone or norethindrone and estrogens or promegestone and estradiol). The average age of the participants ranged from 17.9 to 37.2 years. Pain control was observed in all studies and in the majority of them (six) no significant bone loss was demonstrated with this therapy. Discussion: Treatment with GnRH analogue combined with add back therapy for more than 6 months is efficient in controlling pain, does not promote significant loss of bone mass during use for twelve months and after interruption of therapy there is a gradual recovery of mass density bone, however there may be refractoriness of symptoms. Conclusion: The studies suggest to the safety of prolonged use of GnRH analogues, despite the bone mass’s loss associated.