Combined use of a long-acting gonadotropin-releasing hormone agonist and low-dose danazol in advanced stage endometriosis

Abstract

In this preliminary study, the safety and efficacy of a combined GnRHa and low-dose danazol regimen was evaluated in patients with advanced stage endometriosis. Five patients with stage IV endometriosis were administered triptorelin 3.75 mg intramuscularly with monthly intervals in combination with oral danazol 100 mg/day for 6 months. Laparoscopy was performed before and after therapy to assess the change in endometriotic lesions. During controls, patients were evaluated for the change in hormonal and biochemical parameters and the side effects of the treatment. In 4 patients with ovarian endometriomas, cysts were drained during initial laparoscopy. None of the endometriomas persisted after therapy. Total scores, according to the revised American Fertility Society classification of endometriosis were, 54.8 ± 10.9 before treatment and decreased to 31.6 ± 10.3 ( P < 0.05), whereas, endometriotic implants scores changed from an initial value of 22.8 ± 12.1 to 1.2 ± 1.1 ( P < 0.05). No adverse effect was observed on lipid and liver metabolism. Estrogen deprivation symptoms and oily skin were the most prominent complaints and one patient had a weight gain of 6 kg. Based on these results we conclude that a combination of GnRHa and low dose danazol is an effective alternative treatment modality in the treatment of severe endometriosis without any serious side effect.