• Errico Zupi, Daniela Marconi, Marco Sbracia, Fulvio Zullo, Bonaventura De Vivo, Caterina Exacustos, and Giuseppe Sorrenti.
• Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy.
• Fertil. Steril. 2004 Nov 1;82(5):1303-8.

ObjectiveTo determine the efficacy of GnRH analogue plus add-back therapy compared with GnRH analogue alone and estroprogestin in patients with relapse of endometriosis-associated pain.DesignRandomized, controlled study.SettingUniversity hospital.Patient(S)One hundred thirty-three women with relapse of endometriosis-related pain after previous endometriosis surgery.Intervention(S)Forty-six women were treated with GnRH analogue plus add-back therapy, 44 women were given GnRH analogue alone, and 43 women received estroprogestin, for 12 months.Main Outcome Measure(S)Pain evaluation by a visual analogue scale, quality of life in treated patients according to the SF-36 questionnaire, and occurrence of adverse effects, including bone mass density loss, at pretreatment, after 6 months of treatment, at the end of treatment (12 months), and 6 months after discontinuation of treatment.Result(S)Patients treated either with GnRH analogue alone or GnRH analogue plus add-back therapy showed a higher reduction of pelvic pain, dysmenorrhea, and dyspareunia than patients treated with oral contraceptive, whereas patients treated with add-back therapy showed a better quality of life, as assessed with the SF-36 questionnaire, and adverse effects rate than the other two groups.Conclusion(S)Add-back therapy allows the treatment of women with relapse of endometriosis-associated pain for a longer period, with reduced bone mineral density loss, good control of pain symptoms, and better patient quality of life compared with GnRH analogue alone or oral contraceptive.

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