The use of alternative administration regimens of gonadotropin-releasing hormone agonists in the treatment of endometriosis

Gonadotropin-releasing hormone (GnRH) agonists, which significantly suppress steroidogenesis, lead to anovulation and temporary secondary amenorrhea. This contributes to the regression of endometriotic lesions and a decrease in the clinical symptoms of endometriosis. These medications have been successfully used for many years as a treatment for endometriosis. GnRH agonists (Buserelin depot) are highly effective in treating endometriosis but can lead to side effects associated with hypoestrogenemia. For many years, researchers have been searching for ways to reduce the severity of the condition without compromising the effectiveness of the treatment. Attempts to use a dose-dependent effect and short courses of treatment have not led to positive clinical results, and a widespread add-back therapy has not reduced the cost of treatment. However, this approach is still used due to a lack of alternative treatment regimens. At the same time, extending the inter-injection interval may be a promising option to improve the acceptance of long-term treatment with GnRH agonists. The theoretical basis for this is the ability to block the pituitary receptors for luteinizing and follicle-stimulating hormones for more than 45–50 days. A number of studies conducted by the foreign and Russian scientists confirm the comparable effectiveness of the 4- and 6-week inter-injection interval in the treatment of pain syndrome in endometriosis and in the use of Buserelin depot.

Conclusion: Endometriosis is not only a disease that is resistant to progesterone, but above all, it is an estrogen-dependent condition. There is currently no data in the literature on the response of endometriosis to therapy that creates a hypoestrogenic environment, therefore, GnRH agonists are likely to remain the medications of choice for treating severe forms of endometriosis for a long time. A dosing regimen of GnRH agonists with an extended interval (6 weeks) will reduce treatment costs and the incidence of side effects, as well as reduce the number of cases of forced discontinuation of treatment.