IMR Press / CEOG / Volume 50 / Issue 10 / DOI: 10.31083/j.ceog5010224
Open Access Review
Add-Back and Combined Regulation in GnRH-a Treatment of Endometriosis
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1 Department of Gynecology, the Affiliated Changzhou Second People's Hospital of Nanjing Medical University, 213000 Changzhou, Jiangsu, China
2 Department of Obstetrics and Gynecology, Second Affiliated Hospital of Chongqing Medical University, 400010 Chongqing, China
3 Department of Gynecology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, 230031 Hefei, Anhui, China
*Correspondence: (Bairong Xia); (Jiming Chen)
These authors contributed equally.
Clin. Exp. Obstet. Gynecol. 2023, 50(10), 224;
Submitted: 5 April 2023 | Revised: 6 June 2023 | Accepted: 7 July 2023 | Published: 23 October 2023
Copyright: © 2023 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Objective: The purpose of this review is to summarize drug selection for peri-menopausal symptoms caused by gonadotropin releasing-hormone agonist (GnRH-a) in the treatment of endometriosis. Mechanism: GnRH-a treatment often leads to low estrogen levels, resulting in peri-menopausal symptoms and osteoporosis. Add-back therapy relieves clinical symptoms by supplementing low-dose estrogen. The idea of “combined regulation” is to improve symptoms by adding plant preparations or proprietary Chinese medicines. Studies have shown that they may play a role by regulating serotonin activity. Findings in Brief: For patients treated with GnRH-a for less than 3 months, the combined-regulation regimen can be considered, whereas for patients who have had more than 3 courses of GnRH-a, add-back therapy with sex hormones must be used because the patients will have begun to have obvious bone-mass loss and even bone pain; this bone-mass loss is often irreversible. Conclusions: In the early treatment of endometriosis with GnRH-a, non-hormone combined-regulation therapy is a relatively safe and feasible choice, but hormone add-back therapy should be selected for patients who have had more than 3 courses of GnRH-a.

add-back therapy
combined regulation
sex hormone
2022CZBJ074/Top Talent of Changzhou “The 14th Five-Year Plan” High-Level Health Talents Training Project
RC202101/maternal and child health key talent project of Jiangsu Province
F202138/maternal and child health research project of Jiangsu Province
2019K064/Scientific Research Support Program for Postdoctoral of Jiangsu Province
BRA2019161/Scientific Research Support Program for “333 Project” of Jiangsu Province
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