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The Effect of Hormonal Add-Back Therapy in Adolescents Treated With a Gonadotropin Releasing Hormone (GnRH) Agonist for Endometriosis: A Randomized Trial

      Endometriosis is a debilitating disease complicated by pain, bleeding, limitation of activities, and poor social function. Gonadotropin releasing hormone agonists (GnRHa) are utilized for patients who have failed primary therapy. Long term GnRHa use is associated with deleterious effects on bone mineralization; adults lose 5-8% of spinal BMD after only 3-6 months of treatment. Add-back therapy is a promising adjunct to treatment, but has never been studied in adolescents, who are at high risk for the negative impact of GnRHa. We sought to determine whether add-back with norethindrone acetate (NET) or NET + conjugated equine estrogens (CEE) is superior to maintain bone health in adolescents treated with GnRHa for endometriosis.
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