Lupron Depot® GnRHa Therapy for Endometriosis

The Role of GnRHa Therapy in Endometriosis

Treatment with a GnRH agonist such as Lupron Depot can provide effective relief for endometriosis pain.¹ Learn more about:

Atypical and deep lesions may be more likely to cause pain,^2,5,6,12 and can be difficult to visualize⁷ and remove laparoscopically.^5,12
OC failure. Following oral contraceptives failure, GnRHa therapy may lead to disease improvement. Lupron Depot has a different mechanism of action than OCs.³
Clinical diagnosis. American College of Obstetrics and Gynecology (ACOG) clinical management guidelines (2004) support clinical diagnosis without laparoscopy as an acceptable approach to treatment.⁴
Maximizing Outcomes. GnRH agonist therapy can help maximize outcomes post laparoscopy in patients with endometriosis.^5,12

Atypical and Deep Lesions

For women who have atypical and deep endometrial lesions, the treatment picture is complicated by the fact that these lesions are difficult to visualize⁷ and remove laparoscopically,^5,12 yet such lesions may be more likely to be painful.^2,5,6,12

Atypical Lesions May Be Difficult to Visualize⁷

Endometriosis and Atypical Lesions Info from TAP Pharmaceuticals

Atypical lesions such as red vascular, clear, and white scar lesions may be difficult to visualize laparoscopically.

Atypical Lesions May Be More Likely to Cause Pain (n = 50)²

Endometriosis Pain and Lupron Depot® (leuprolide acetate)

Pain perception was measured in normal looking tissue up to 28 mm from the lesion.

Deep Endometriosis Can Make Surgical Management Difficult

Lesions that appear superficial on the surface may actually be deep, large lesions⁶ which may be too deep for surgical ablation.¹² For such patients, treatment with a GnRH agonist such as Lupron Depot may provide an effective option for pain relief.

Oral Contraceptives (OC) Treatment Failure

Many endometriotic lesions do not respond predictably to cyclical endogenous or exogenous hormones.⁹ ACOG guidelines recommend that, "Oral contraceptives probably should not be used for more than 3 months if the patient experiences no relief of symptoms."⁵ Lupron Depot has a different mechanism of action than OCs.³ Consider Lupron Depot when OCs fail.

Clinical Diagnosis for Suspected Endometriosis

The 2004 ACOG clinical management guidelines support the practice that laparoscopic examination is not a prerequisite to providing medical therapy for women with chronic pelvic pain and suspected endometriosis.⁴ Patients whose pain is unresponsive to Non-Steroidal Anti-Inflammatory Drugs (NSAIDs),¹⁰ antibiotics,¹¹ or a 3-month trial of OCs^4,5 should be considered for a trial of GnRH agonist therapy.⁵

Workup for Chronic Pelvic Pain and Suspected Endometriosis^4,10,11

Lupron Depot and Pelvic Pain from Endometriosis

Maximizing Outcomes in Endometriosis Patients

Patients can be symptom-free when GnRH agonist therapy is used to treat minimal disease. Five years after a full 6 months of therapy, 63% of patients with minimal disease were symptom-free (N = 130). Drugs used in this study were: goserelin acetate implant, nafarelin acetate, and buserelin acetate.¹³

Learn more about Lupron Depot

Now you can order Lupron Depot online. Once you've set up an account, it only takes a few clicks.

Staffed by registered nurses, ScriptAssist is a supportive service for patients taking Lupron Depot.

Important Safety and Other Information

Side effects are generally those related to hypoestrogenism, including vasomotor flushes, headaches, and vaginal dryness. After 6 months of therapy with Lupron Depot 3.75 mg, vertebral bone density decreased by an average of 3.2% compared with the pretreatment value. Lupron Depot is indicated for the management of endometriosis, including pain relief and reduction of endometriotic lesions. Individual results may vary. Please see the full Prescribing Information for Lupron Depot 3.75 mg and -3 Month 11.25 mg dosage forms, and the Patient Product Information for the 3.75 mg and -3 Month 11.25 mg dosage forms.

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References

Dlugi AM, Miller JD, Knittle J. Lupron Depot (leuprolide acetate for depot suspension) in the treatment of endometriosis: a randomized, placebo-controlled, double-blind study. Lupron Study Group. Fertil Steril. 1990;54(3):419-427.
Demco L. Mapping the source and character of pain due to endometriosis by patient-assisted laparoscopy. J Am Assoc Gynecol Laparosc. 1998;5(3):241-245.
Bergqvist IA. Hormonal regulation of endometriosis and the rationales and effects of gonadotrophin-releasing hormone agonist treatment: a review. Hum Reprod. 1995;10(2):446-452.
ACOG Practice Bulletin No. 51. Chronic pelvic pain. March 2004. Obstet Gynecol. 2004;103(3):589-605.
ACOG Practice Bulletin. Medical management of endometriosis. Number 11, December 1999 (replaces Technical Bulletin Number 184, September 1993). Clinical management guidelines for obstetrician-gynecologists. Int J Gynaecol Obstet. 2000;71(2):183-196.
Koninckx PR, Martin DC. Deep endometriosis: a consequence of infiltration or retraction or possibly adenomyosis externa? Fertil Steril. 1992;58(5):924-928.
Murphy AA, Green WR, Bobbie D, dela Cruz ZC, Rock JA. Unsuspected endometriosis documented by scanning electron microscopy in visually normal peritoneum. Fertil Steril. 1986;46(3):522-524.
Martin DC, Hubert GD, Vander Zwaag R, el-Zeky FA. Laparoscopic appearances of peritoneal endometriosis. Fertil Steril. 1989;51(1):63-67.
Tamaya T, Motoyama T, Ohono Y, et al. Steroid receptor levels and histology of endometriosis and adenomyosis. Fertil Steril. 1979;31(4):396-400.
Ling FW. Randomized controlled trial of depot leuprolide in patients with chronic pelvic pain and clinically suspected endometriosis. Pelvic Pain Study Group. Obstet Gynecol. 1999;93(1):51-58.
Scialli AR. Evaluating chronic pelvic pain: a consensus recommendation. Pelvic Pain Expert Working Group. J Reprod Med. 1999;44(11):945-952.
Winkel CA, Bray M. Use of leuprolide acetate in combination with surgical treatment for women with endometriosis. In: Minaguchi H and Sugimoto O, eds. Endometriosis Today, Advances in Research and Practice: The Proceedings of the Vth World Congress on Endometriosis, Yokohama, Japan, October 1996. New York, NY: Parthenon Publishing Group; 1997:365-369.
Waller KG, Shaw RW. Gonadotropin-releasing hormone analogues for the treatment of endometriosis: long-term follow-up. Fertil Steril. 1993;59(3):511-515.


Endometriosis Main Hormone Therapy About Lupron Depot Efficacy Dosing & Administration Safety Information Resources for Your Patients Links Procurement Physician Materials Links	The Role of GnRHa Therapy in Endometriosis Treatment with a GnRH agonist such as Lupron Depot can provide effective relief for endometriosis pain.¹ Learn more about: Atypical and deep lesions may be more likely to cause pain,^2,5,6,12 and can be difficult to visualize⁷ and remove laparoscopically.^5,12 OC failure. Following oral contraceptives failure, GnRHa therapy may lead to disease improvement. Lupron Depot has a different mechanism of action than OCs.³ Clinical diagnosis. American College of Obstetrics and Gynecology (ACOG) clinical management guidelines (2004) support clinical diagnosis without laparoscopy as an acceptable approach to treatment.⁴ Maximizing Outcomes. GnRH agonist therapy can help maximize outcomes post laparoscopy in patients with endometriosis.^5,12 Atypical and Deep Lesions For women who have atypical and deep endometrial lesions, the treatment picture is complicated by the fact that these lesions are difficult to visualize⁷ and remove laparoscopically,^5,12 yet such lesions may be more likely to be painful.^2,5,6,12 Atypical Lesions May Be Difficult to Visualize⁷ Atypical lesions such as red vascular, clear, and white scar lesions may be difficult to visualize laparoscopically. Atypical Lesions May Be More Likely to Cause Pain (n = 50)² Pain perception was measured in normal looking tissue up to 28 mm from the lesion. Deep Endometriosis Can Make Surgical Management Difficult Lesions that appear superficial on the surface may actually be deep, large lesions⁶ which may be too deep for surgical ablation.¹² For such patients, treatment with a GnRH agonist such as Lupron Depot may provide an effective option for pain relief. Oral Contraceptives (OC) Treatment Failure Many endometriotic lesions do not respond predictably to cyclical endogenous or exogenous hormones.⁹ ACOG guidelines recommend that, "Oral contraceptives probably should not be used for more than 3 months if the patient experiences no relief of symptoms."⁵ Lupron Depot has a different mechanism of action than OCs.³ Consider Lupron Depot when OCs fail. Clinical Diagnosis for Suspected Endometriosis The 2004 ACOG clinical management guidelines support the practice that laparoscopic examination is not a prerequisite to providing medical therapy for women with chronic pelvic pain and suspected endometriosis.⁴ Patients whose pain is unresponsive to Non-Steroidal Anti-Inflammatory Drugs (NSAIDs),¹⁰ antibiotics,¹¹ or a 3-month trial of OCs^4,5 should be considered for a trial of GnRH agonist therapy.⁵ Workup for Chronic Pelvic Pain and Suspected Endometriosis^4,10,11 Maximizing Outcomes in Endometriosis Patients Patients can be symptom-free when GnRH agonist therapy is used to treat minimal disease. Five years after a full 6 months of therapy, 63% of patients with minimal disease were symptom-free (N = 130). Drugs used in this study were: goserelin acetate implant, nafarelin acetate, and buserelin acetate.¹³ Learn more about Lupron Depot	Now you can order Lupron Depot online. Once you've set up an account, it only takes a few clicks. Staffed by registered nurses, ScriptAssist is a supportive service for patients taking Lupron Depot.