562 Obstetrics and Gynecology Board Review •••
❍ Does add-back therapy decrease the effectiveness of the GnRH agonist?
No.
❍ Is GnRH agonist therapy effective for the treatment of pelvic pain due to endometriosis in patients who
failed treatment with NSAIDs or oral contraceptives (OCPs)?
Yes.
❍ Which GnRH agonists are FDA-approved in the United States for the treatment of endometriosis?
Leuprolide, nafarelin, and goserelin.
❍ What is the total time (in months) approved by the FDA to utilize GnRH agonists?
12 months. The dose may be initiated for 6 months and then repeated or continued for an additional 6 months.
❍ According to ACOG guidelines, should empiric GnRH agonist treatment be used in adolescents <18 years
old for presumed endometriosis?
No.
❍ True or False: GnRH agonists can be used in the treatment of leiomyomatosis peritonealis disseminata and
adenomyosis.
True.
❍ What are the contraindications to GnRH agonist therapy?
Pregnancy, undiagnosed abnormal uterine bleeding, breastfeeding, undiagnosed pelvic mass, and reproductive tract
neoplasia.
❍ What change in the circulating levels of FSH and LH is seen shortly after initiation of the GnRH agonist
treatment?
An increase in FSH and LH (flare effect).
❍ What is the duration of initial agonist phase of GnRH?
1 to 3 weeks.
❍ What are the mechanisms that cause a hypogonadotropic, hypogonadal state after prolonged administration
of GnRH antagonist?
Desensitization, downregulation of the receptors, and secretion of biologically inactive gonadotropins.
❍ Desensitization is?
The uncoupling of GnRH peptide/receptor complex from any intracellular actions.
❍ Downregulation refers primarily to?
The decrease in the number of cell surface GnRH receptors.