The Effect Of GnRHa Combined With Add-back Therapy On The Serum Hormone And MMP-9in The Treatment For Endometriosis

Objective: The present study was to evaluate the clinical results of pain,hypoestrogenic symptoms, the serum hormone and MMP-9for the GnRHacombined with estrogen-progestegen add-back therapy in the treatment forendometriosis after conservative operation to investigate the efficacy andsafety of our add-back procedure.Methods: Sixty-seven women with endometriosis after conservativesurgery （laparoscopically and traditionally, rAFS III-IV with pathologicaldiagnosis） between June,2011and December,2012in our hospital wereconsented to participate in the present study. They were randomly assignedinto two groups as GnRHa group （Group G） and Add-back group （Group A）.All the patients received the injection of the zoladex （3.6mg i.h.） in every28days and for three times in all. The women in Group A were additionally giventhe progynova （0.5mg/d） and dydrogesterone （5mg/d） from the secondinjection of zoladex for two months. Before and after the treatment, the degreeof pain was graded according to the visual analog scale （VAS）. The serumlevels of the E₂, FSH, LH and MMP-9were measured before the treatment,one month and three months after the treatment. The menopausal symptomswere assessed with the Kupperman Menopausal Index three months after thetreatment.Result: After three months treatment, sixty patients were available for thepresent analysis, with28women in Group G and32women in Group A. TheVAS score was decreased from the7.9±1.5to1.4±1.0in Group G, and from7.8±1.4to1.4±1.0in Group A. There was no statistical difference betweentwo groups before and after the treatment. Three months later, the KuppermanScore were15.5±7.3and10.5±6.1in the Group G and Group A, withstatistical difference between two groups. For the incidence rate of specific menopausal symptoms in two groups, the hot flash were89.3%and50.0%,mood swings were53.6%and22.2%, bone pain were35.7%and13.9%, withstatistical difference between two groups. During the treatment, the serumlevels of E₂, FSH and LH were decreased gradually and with statisticaldifference between the three months and the start of treatment. At the threemonths treatment, the serum level of E₂was11.6±6.9pg/ml in Group G,significantly lower than the Group A of21.7±9.1pg/ml; the serum level ofFSH was6.3±2.7mIU/ml, significantly higher than the Group A of21.7±9.1pg/ml. The serum level of MMP-9was decreased from the385.7±76.8ng/mlto174.4±75.9ng/ml in Group G, and from374.5±70.8ng/ml to193.6±70.7ng/ml in Group A. There was statistical difference before and after thetreatment in both groups, but no statistical difference was between two groups.Statistical analysis showed a strong positive correlation between serumMMP-9expression and serum E₂, FSH and LH levels in both groups.Conclusion: The application of GnRHa in combination with low-doseestrogen and progesterone add-back therapy in patients with endometriosisafter conservative surgery can relieve chronic pain of pelvic pain,dysmenorrhea, and sexual pain and can effectively relieve the low estrogensymptoms, especially hot flashes, night sweats, mood swings, bone pain andso on. It can reduce hormone expression and maintain serum estrogen levels inthe therapeutic range in the postoperative course of treatment. Serum MMP-9and serum E₂, FSH and LH levels have a strong positive correlation and areclosely related to the occurrence of endometriosis, so it can be as a goodclinical detection indicator for the endometriosis. In conclusion, clinicalapplication of GnRHa in combination with low-dose estrogen and progestinadd-back therapy is safe and effective to endometriosis after conservativesurgery.