Endometriosis Research Center Challenges GnRH Agonist Usage Guidelines

The Endometriosis Research Center has issued a position statement challenging recent guidelines set forth by a Panel of physicians and consensus guideline development professionals, calling the recommendations "unethical."

A recent consensus statement regarding the use of GnRH agonists in the management of Endometriosis has prompted a challenging response from the Endometriosis Research Center. The consensus statement, released in a recent Journal of Fertility & Sterility, advocates the use of GnRH agonists such as Lupron® in women who have not been surgically diagnosed with the disease. The ERC called such usage "unethical," and raised concerns about the lack of inclusion of well-regarded Endometriosis specialists on the consensus panel.

Citing the limitations and often significant side effects of GnRH agonists, the organization acknowledged that GnRH therapy has a place in Endometriosis treatment; however, such presumptive usage in younger and undiagnosed women puts patients at risk of delayed diagnosis and necessary surgical treatment, and exposes them to significant side effects of the medication, perhaps needlessly.

Research data is replete with confirmation of the fact that Endometriosis, while suspected, cannot be firmly diagnosed without biopsy. Such biopsy is generally obtained through a laparoscopic procedure, during which time the patient can also have the implants removed. The ERC suggests that, although there is no absolute cure for Endometriosis, obtaining early diagnosis and complete surgical eradication of disease by an expert surgeon is far more likely to offer the patient long term relief than GnRH therapy.

"Indeed, Lupron® and it's competitors all have a place in Endometriosis treatment. However, is it unacceptable practice for a gynecologist to administer such therapies to the undiagnosed or adolescent patient," said Heather C. Guidone, ERC Director of Operations. "Exposing a woman or teen to the potentially long term and negative side effects experienced by so many who have undergone GnRH therapy simply on the basis that she 'may' have Endometriosis lacks good judgment. Simply because a woman experiences a decrease in pain during GnRH treatment, does not mean she has Endometriosis. Likewise, simply because she doesn't respond well, it does not mean she doesn't have the disease. The gold standard of diagnosis and treatment continues to be of a surgical nature," said Guidone. "Physicians should be seeking to improve their understanding of the disease and increasing their skills at treating it surgically, rather than looking for a cookie-cutter approach to treating all cases through a quick-fix."

In one ERC survey, results showed that only 27.71% of the organization's members found Lupron® therapy to be "tolerable and helpful," while an overwhelming 48.19% indicated that Lupron® was "intolerable and not helpful at symptom relief." 7.23% found Lupron® to be "tolerable, but not helpful," and the remaining 16.87% found Lupron® to be "intolerable, but nonetheless helpful" with their symptoms. These results are strikingly different from the experiences and information propagated by some sources within the medical community and on various websites hosted by the manufacturer of Lupron®.

GnRH therapy is intended for patients ages 18 and over, in whom Endometriosis is a diagnosed cause of pelvic pain. In their paper, the organization stressed that further research must be given to the potential long-term effects of GnRH therapy in a woman and possibly even in her offspring, before advocating pre-diagnostic usage. "It took over 30 years to learn the multi-generational, significantly negative effects of DES [diethylstilbestrol]," said Guidone. "Our fear is that the overzealous usage of GnRH therapies might lead to another generation of those who didn't know they were negatively affected until decades later," she said. "Our daughters deserve better than that."

The ERC strongly maintains that "each patient's needs, and the uniqueness of each case, must be thoroughly evaluated before any therapies are offered."

The ERC's complete statement is now available for download from the foundation's website at http://www.endocenter.org/pdf/PreDiagnosisGnRH.pdf.

The Endometriosis Research Center is an International 501(c)3 non profit organization which offers education, awareness, support and research facilitation on the disease. For more information on the ERC or it's programs, visit http://www.endocenter.org or call toll free 800/239-7280.