GnRH agonists combined with steroid "add-back"

Low-dose steroid hormone regimen	Comment	Investigator
Transdermal estradiol patch 25 mcg/day, plus medroxyprogesterone acetate 2.5 mg daily	This regimen did not completely prevent bone loss. The estradiol concentration achieved is in the range of 30 pg/mL.	Howell, 1995
Norethindrone acetate 5 mg daily	This is a very high dose of progestin, which is associated with a decrease in HDL cholesterol.	Hornstein, 1997
Conjugated equine estrogen 0.625 mg plus norethindrone acetate 5 mg daily	This regimen prevented bone loss and markedly reduces the vasomotor symptoms reported. Pain relief was excellent.	Hornstein, 1997
Conjugated equine estrogen 0.625 mg plus medroxyprogesterone acetate 5 mg daily	This regimen did not completely prevent bone loss.	Moghissi, 1998
Conjugated equine estrogen 0.3 mg plus medroxyprogesterone acetate 2.5 mg daily	This regimen did not completely prevent bone loss.	Moghissi, 1998
Transdermal estradiol 25 mcg/day, plus norethindrone acetate 5 mg daily	This regimen did not completely prevent bone loss.	Zupi, 2004

GnRH agonist treatment combined with low-dose steroid "add-back" causes atrophy in endometriosis, improves pelvic pain, and minimizes vasomotor symptoms and bone loss. The low-dose steroid hormone regimens that have been documented to be effective in randomized clinical trials when used in combination with a GnRH agonist are listed above.

GnRH: gonadotropin-releasing hormone; HDL: high-density lipoprotein.

Courtesy of Robert L. Barbieri, MD.

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GnRH agonists combined with steroid "add-back"