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

This study has been completed.
Brigham and Women's Hospital
Information provided by (Responsible Party):
Amy DiVasta, Children's Hospital Boston Identifier:
First received: May 15, 2007
Last updated: November 12, 2014
Last verified: November 2014

The purpose of this study is to determine whether a regimen of norethindrone acetate + placebo or norethindrone acetate + conjugated estrogens is superior in maintaining skeletal health and quality of life in adolescents treated with a GnRH agonist for endometriosis.

Condition Intervention Phase
Drug: Conjugated equine estrogens
Drug: Placebo
Drug: Norethindrone acetate
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: The Effect of Hormonal Add-Back Therapy in Adolescents Treated With a GnRH Agonist for Endometriosis: A Randomized Trial

Resource links provided by NLM:

Further study details as provided by Children's Hospital Boston:

Primary Outcome Measures:
  • Bone mineral density [ Time Frame: 12 months ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Volumetric bone mineral density [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  • Quality of life [ Time Frame: 12 months ] [ Designated as safety issue: Yes ]

Enrollment: 53
Study Start Date: August 2007
Study Completion Date: November 2014
Primary Completion Date: October 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: I Drug: Conjugated equine estrogens
Conjugated estrogens 0.625 mg PO daily
Other Name: Premarin
Drug: Norethindrone acetate
Norethindrone acetate 5 mg PO daily
Other Name: Aygestin
Placebo Comparator: N
Placebo group
Drug: Placebo
Placebo capsule 1 pill PO daily
Drug: Norethindrone acetate
Norethindrone acetate 5 mg PO daily
Other Name: Aygestin

Detailed Description:

Endometriosis has become increasingly recognized as a chronic illness which begins during adolescence. Untreated endometriosis may lead to chronic pain and infertility. As recognition of the need for prompt therapy increases, so does the length of time patients will be exposed to treatments. As a result, there exists a pressing need to evaluate adjunctive measures that may limit the associated negative health consequences of treatment.

A gonadotropin-releasing hormone (GnRH) agonist is one medication utilized for patients who have failed other treatments. While GnRH-agonists are effective in relieving symptoms, their long-term use is problematic. GnRH agonists induce a low-estrogen state, causing deleterious effects on bone mineralization. These negative consequences are especially important for our pediatric patients. Adolescence is the critical period in a woman's life for bone acquisition and attainment of peak bone mass. Anything that interferes with this process puts patients at risk for lifelong low bone density and future fracture.

"Add-back" therapy appears to be a promising adjunct to treatment for prevention of this bone loss. Daily therapy with low-doses of hormones preserves bone density in adult patients, without altering the efficacy of the GnRH-agonist. However, no data exist on the effect of add-back therapy in adolescents.

The aim of the current study is to evaluate the safety and efficacy of two add-back regimens, norethindrone acetate + placebo or norethindrone acetate + conjugated estrogens, for the preservation of skeletal health and quality of life in adolescents with endometriosis treated with a GnRH-agonist.


Ages Eligible for Study:   13 Years to 22 Years
Genders Eligible for Study:   Female
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Age 13-22 years, at least two years post-menarche
  • Body mass index (BMI, kg/m2) between 18 -30 kg/m2
  • Surgical diagnosis of endometriosis
  • Clinical decision to treat with a GnRH agonist, leuprolide depot (Lupron Depot®; TAP Pharmaceuticals, Inc.) 11.25 mg IM every 3 months

Exclusion Criteria:

  • Concomitant chronic diseases which affect bone health, such as cystic fibrosis, inflammatory bowel disease, renal disease, or diabetes mellitus
  • Markedly impaired liver function or liver failure
  • Personal history of thromboembolic event (such as deep venous thrombosis)
  • Medication use known to affect bone metabolism:

    • Glucocorticoid therapy (including inhaled steroids) or anticonvulsants used in the last 6 months
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Please refer to this study by its identifier: NCT00474851

United States, Massachusetts
Children's Hospital Boston
Boston, Massachusetts, United States, 02115
Sponsors and Collaborators
Children's Hospital Boston
Brigham and Women's Hospital
Principal Investigator: Amy D DiVasta, MD, MMSc Children's Hospital Boston
  More Information

No publications provided

Responsible Party: Amy DiVasta, Principal Investigator, Children's Hospital Boston Identifier: NCT00474851     History of Changes
Other Study ID Numbers: 07-01-0004
Study First Received: May 15, 2007
Last Updated: November 12, 2014
Health Authority: United States: Food and Drug Administration

Keywords provided by Children's Hospital Boston:
Bone density
GnRH Agonist
Add-back therapy

Additional relevant MeSH terms:
Genital Diseases, Female
Norethindrone acetate
Contraceptive Agents
Contraceptive Agents, Female
Contraceptives, Oral
Contraceptives, Oral, Synthetic
Pharmacologic Actions
Physiological Effects of Drugs
Reproductive Control Agents
Therapeutic Uses processed this record on March 25, 2015