GnRH agonist analogues with and without add back

GnRH agonist analogues are extremely effective [11]. These are best administered by injected depot preparations (goserelin or leuprorelin) as compliance is virtually guaranteed. Remember that as these are agonist analogues missed nasal doses will result in incomplete suppression and even re-stimulation of cycles. Without add back there will usually be the distressing symptoms of menopause. With add back therapy (particularly tibolone) the analogues remain equally effective but menopause symptoms are eliminated [11]. It is difficult to know whether long-term use of this combination is justified either medically or economically. It is probably reasonable to use it in those women approaching the menopause and in the medium term in younger women.

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