Buserelin acetate implants in the treatment of pain in endometriosis.

OBJECTIVE

To examine the treatment of pain in endometriosis by buserelin acetate implants.

DESIGN

Fourteen patients with laparoscopically confirmed pelvic endometriosis were included in the study. All presented with severe dysmenorrhea with or without deep dyspareunia and pelvic pain. Buserelin acetate 6.6 mg. Implants were injected subcutaneously in the lateral region of the anterior abdominal wall, 3 doses every 8 weeks in group 1 (n=7) and 2 doses every 12 weeks in group 2 (n=7). Bone mineral density (BMD) was measured at the lumbar spine by dual energy X-ray absorptiometry (DEXA) before initiation of treatment and 1 year after. Symptoms, pelvic examination, ultrasonogram and serum estradiol were recorded every 4 weeks until two regular menses were established.

RESULTS

All the painful symptoms were relieved and eventually disappeared in every patient within 4-6 weeks. Mean duration of amenorrhea in group 1 (408.4+/-47.7 days) was significantly longer than group 2 (331.3+/-22.4 days), p < 0.01. Mean duration of first observed side effects was 2.7+/-1.6 weeks. Hot flushes were the most common side effects. Serum estradiol levels were below 15 pg/ml in all patients and there were no significant differences between the two groups during amenorrhea. There was significant bone loss in both groups, 6.49+/-4.90 per cent in group 1 and 7.71+/-5.67 per cent in group 2. However, there were no significant differences between the two groups for lumbar BMD before and after treatment.

CONCLUSION

Buserelin acetate implants are effective in the treatment of pain in endometriosis. These implants should have an important clinical application when chronic treatment is indicated. Further study is needed to design how this preparation should be used to minimize the adverse effects.