Gonadotropin-releasing hormone analogues for the treatment of endometriosis: long-term follow-up

Objective:To determine the long-term recurrence rate of endometriosis after treatment with gonadotropin-releasing hormone analogues (GnRH-a).Design:A historical prospective study.Setting:Royal Free Hospital, London, a tertiary referral center for the treatment of endometriosis.Patients:One hundred thirty patients with endometriosis had treatment with GnRH-a buserelin acetate, goserelin, and nafarelin acetate between the years 1985 and 1987. Patients no longer being followed in the gynecology clinic were sent a questionnaire to determine their state of health. Information was also requested from the patient’s general practitioner.Main outcome measures:The cumulative recurrence rate for the fifth year after treatment ended was 53.4%.Results:Patients with a higher disease stage at the outset were more likely to experience recurrence and experience it earlier than patients with minimal disease. Fifth-year recurrence rates were 36.9% for minimal disease and 74.4% for severe disease. The change in endometriosis stage classification scores at second-look laparoscopy for those patients whose disease recurred after treatment was not significantly different from those whose disease did not recur during the study period.Conclusions:Patients with endometriosis treated with GnRH-a are highly likely to suffer a recurrence of their disease, particularly if their disease is severe at the outset.