***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: An open-label r and omized pilot study was conducted to evaluate the efficacy and acceptability of 6 months treatment with leuprolide in a 3-monthly versus a monthly i.m . depot injection for the relief of chronic pelvic pain in women with endometriosis . A total of 30 women aged 18 - 38 years were allocated to the 3-monthly depot arm ( n = 15 ) or to the monthly depot arm ( n = 15 ) after laparoscopic diagnosis of pelvic endometriosis .  Mean ( SD ) deep dyspareunia scores according to a 0 - 3 point verbal rating scale decreased from 1.8 ( 0.9 ) at baseline to 1.3 ( 0.7 ) at the end of treatment in the 3-monthly depot group and from 2.1 ( 1.2 ) to 1.3 ( 0.7 ) in the monthly depot group . Corresponding values in non-menstrual pain scores fell from 2.1 ( 0.6 ) to 1.1 ( 0.3 ) , and from 2.1 ( 0.8 ) to 1.2 ( 0.4 ) respectively , without statistically significant differences between the groups . Serum luteinizing hormone ( LH ) and 17 beta-oestradiol concentrations were significantly suppressed at 12 and 24 weeks compared with baseline values , without differences between the groups . The monthly depot caused a slightly more marked inhibition of serum follicle stimulating hormone ( FSH ) levels with respect to the 3-monthly preparation . Mean ( SD ) endometriosis scores at baseline and at 6-month follow-up laparoscopy were respectively 32.8 ( 25.1 ) and 12.2 ( 9.3 ) in the 3-monthly depot group and 29.0 ( 22.7 ) and 13.1 ( 15.3 ) in the monthly depot group ( paired t-test , P < 0.05 ) . Mean percentage decrease in lumbar spine bone mineral density was 5.2 % in the former and 4.9 % in the latter subjects . In the 3-monthly depot group , 13 women grade d the tolerability of their treatment schedule as " good ' compared with seven in the monthly depot group ( chi 2 = 5.40 , P = 0.02 ) OBJECTIVE To determine whether treatment of endometriosis with a GnRH analogue ( GnRH-a ; goserelin ) combined with continuous estrogen and progestogen hormone replacement therapy ( HRT ) would prevent the hypoestrogenic effects , including loss of bone density , while maintaining efficacy for treatment of endometriosis . DESIGN R and omized controlled trial . PATIENTS Fifty premenopausal women with laparoscopically diagnosed endometriosis ( revised American Fertility Score for endometriosis implants equal to four or greater ) and significant symptoms of dysmenorrhoea , dyspareunia , and other pelvic pain . INTERVENTION Patients were r and omized to receive either goserelin alone , 3.6 mg SC depot every 4 weeks for 24 weeks , or goserelin , 3.6 mg SC depot every 4 weeks for 24 weeks , plus HRT ( 25 micrograms transdermal 17 beta E2 daily and 5 mg medroxyprogesterone acetate orally daily ) for 20 weeks commencing with the second goserelin injection . RESULTS There was a significant reduction in the extent of pelvic endometriosis in both groups , with no difference between the groups . Both groups experienced an improvement in symptoms and signs , again with no difference between groups . Hypoestrogenic side effects of hot flushes and loss of libido were significantly less in the group that received HRT . The amount of bone mineral density loss was significantly less in the HRT group at the lumbar spine , although it was not prevented completely . CONCLUSION The addition of HRT to GnRH-a for the treatment of endometriosis did not reduce the efficacy of treatment , and adverse hypoestrogenic effects were decreased , although not abolished Before the 1950s , no medical treatment of endometriosis existed . Patients were subjected to the surgical removal of endometriotic deposits or endometriomas , or to total removal of the uterus and ovaries . Whilst these approaches had varying degrees of success , their main disadvantage was that they rendered many patients infertile . The use of and rogens or progestogens ' to treat endometriosis began during the late 1950s with some early success , but the side effects , which were primarily and rogenic , were so pronounced as to be unacceptable . Progress was made in the 1970s with the introduction of danazol ' , which has gained wide acceptance because of its efficacy in relieving the symptoms of endometriosis . Published data suggest that it is effective in suppressing the symptoms in 40 YO of patients with endometriosis3- " . The incidence of relapse following danazol therapy is , however , relatively high " . ' and , more importantly , the side effects are considerable , particularly weight gain , hirsutism , greasy skin and hair , and mood changes . Such side effects make its acceptability to patients question able . The introduction of gonadotrophin-releasing hormone ( GnRH ) agonists opened up a new avenue of endometriosis treatment , as it allowed the establishment of a temporary hypo-oestrogenic state , whereas previously the most effective therapy had been oophorectomy . The constant administration of a GnRH agonist continuously downregulates the GnRH receptors and suppresses the release of follicle stimulating hormone ( FSH ) and luteinising hormone ( LH ) . thereby creating a temporary menopausal state . The hypo-oestrogenic side effects that result , which include hot flushes , sweating , vaginal dryness , breast atrophy . superficial dyspareunia and loss of libidoalthough temporary-may be as distressing for the patient as the and rogenic side effects caused by danazol . There is also some concern about the effect of GnRH agonist therapy on bone mineral density . In another study reported in this supplement by Fogelman et aLi , the effect of a GnRH agonist on the lumbar spine and femoral neck Add-back hormone replacement therapy has been shown to alleviate some of the hypo-oestrogenic side effects associated with gonadotrophin-releasing hormone agonists , including demineralisation of bone . Studies on patients with uterine fibroids have shown that concomitant add-back therapy reduced the efficacy of these agents , but that deferred administration was less detrimental . This trial set out to investigate if deferred add-back therapy could offer any advantages to patients with endometriosis compared with immediate therapy . Zoladex [ goserelin acetate ( 3.6 mg every 4 weeks ) ] was given for 24 weeks either with placebo , with medrogestone ( 10 mg/day ) for 24 weeks ( immediate add-back therapy ) , or with placebo for 12 weeks followed by medrogestone ( 10 mg/day ) for 12 weeks ( deferred add-back therapy ) to 123 patients . The number of responders measured using the Revised American Fertility Society score ( decrease in this score of > or = 50 % ) was greatest in the immediate add-back therapy group , although there were no significant differences between groups . All three treatment groups showed significant decreases in bone mineral density compared with baseline but smaller losses were generally observed in the add-back groups . A significantly smaller number of patients in the immediate add-back group reported hot flushes during the first 12 weeks of treatment compared with the deferred add-back group . In conclusion , it appears that there is no extra advantage to patients with endometriosis being treated with goserelin in delaying the start of add-back therapy Intermittent PTH administration increases spinal bone mineral density ( BMD ) and prevents bone loss from the hip and total body in young women treated with a long acting GnRH analog for endometriosis . To establish whether these beneficial effects on BMD persist after PTH administration is discontinued , we remeasured BMD and biochemical markers of bone turnover in 38 women with endometriosis who had been treated with a GnRH analog alone ( nafarelin acetate ; 200 microg , intranasally , twice daily ; n = 23 ; group 1 ) or who had received nafarelin plus human PTH-(1 - 34 ) ( 40 microg/day , s.c . ; n = 15 ; group 2 ) for 6 - 12 months 1 yr after therapy was completed . Cyclic menstrual function returned promptly after nafarelin therapy was discontinued . In group 1 , BMD increased significantly at all sites [ P < 0.001 for the anterior-posterior ( AP ) and lateral spine ; P = 0.014 for the femoral neck ; P = 0.004 for the trochanter ] , except the proximal radius ( P = 0.065 ) and total body bone density ( P = 0.069 ) after nafarelin therapy was stopped . In group 2 , BMD increased significantly at the AP spine ( P < 0.001 ) , lateral spine ( P = 0.012 ) , femoral neck ( P = 0.002 ) , and trochanter ( P = 0.029 ) after nafarelin therapy was stopped . BMD of the spine in the AP projection increased more in group 2 and than in group 1 after therapy was stopped ( P = 0.045 ) . Despite these increases after discontinuation of nafarelin therapy , BMD was still significantly below baseline values at the AP spine ( P < 0.001 ) and femoral neck ( P = 0.006 ) and tended to be lower than baseline values at the trochanter ( P = 0.057 ) and total body ( P = 0.101 ) at the end of the 1-yr follow-up period in group 1 . In contrast , BMD was significantly above baseline values at the AP and lateral spine ( P < 0.001 ) sites and was similar to baseline values at the other skeletal sites at the end of the 1-yr follow-up period in group 2 . Bone turnover returned to baseline values in both groups when therapy was stopped . We conclude that the beneficial effects of PTH  on bone persist in women who regain cyclic menstrual function . Although part of the increases in BMD are probably due to restoration of ovarian function , additional increases in BMD most likely represent a further anabolic effect of PTH on bone that is not detected until after PTH administration is stopped The effects of a GnRH agonist and danazol on bone mineral content ( BMC ) in Japanese women with endometriosis were investigated . Nineteen women with laparoscopically confirmed endometriosis were treated with buserelin ( 900 micrograms/d administered intranasally , 10 cases ) or with danazol ( 400 mg/d p.o . , 9 cases ) for 6 months . Trabecular BMC of the 3rd lumbar vertebra was measured using quantitative computerized tomography before treatment , at the end of treatment and 6 months after treatment by the same radiologist who was not informed about the drug used . Serum estradiol and the biochemical parameters of bone metabolism were also measured . A significant decrease in BMC ( 10 % on average ; maximum 25.4 % ) was observed at the end of treatment with buserelin ( p < 0.01 ) and this loss was only partially recovered 6 months after treatment . In the danazol group , however , a slight gain in BMC was observed . Buserelin  suppressed serum estrogen levels much more than danazol did . Parameters of bone resorption tended to increase in the buserelin group . Because treatment with buserelin , but not with danazol , was always associated with a significant decrease in BMC at L3 , repeated usage of buserelin may lead to cumulative bone loss in patients with endometriosis OBJECTIVE To determine changes in trabecular vertebral bone mass , serum E2 , and serum calcitonin during and after therapy of pelvic endometriosis with depot leuprolide acetate ( LA ) or danazol . DESIGN Prospect i ve , r and omized , double-blind study . SETTING Academic university hospital and department of obstetrics and gynecology . PATIENTS Twelve women with symptomatic pelvic endometriosis diagnosed and staged by laparoscopy . INTERVENTIONS All patients received blinded treatment with either 3.75 mg JM depot LA given every month and daily placebo tablets ( n = 6 ) or 800 mg oral danazol daily with a monthly placebo injection ( n = 6 ) for 24 weeks . MAIN OUTCOME MEASURES Quantitated computerized tomography of bone density of thoracic 12 to lumbar 4 vertebral bodies were determined before , at the end of 24 weeks of treatment , and 6 and 12 months after completing treatment . Gain or loss of bone mass was based against pretreatment levels . Serial serum levels of E2 and calcitonin before , throughout , and after therapy were compared with changes in bone mass . RESULTS Bone loss with LA was 14.0 % + /- 0.5 % ( mean + /- SEM ) , recovering to a deficit of 4.2 % + /- 3.8 % and 3.3 % , 6 and 12 months after stopping therapy . Danazol  increased bone by 5.4 % + /- 2.2 % , with a further gain to 8.2 % + /- 3.5 % and 7.5 % , 6 and 12 months after stopping treatment . Serum E2 levels usually were < 25 pg/mL ( conversion factor to SI unit , 3.671 ) with LA but > 47.3 pg/mL 
    Output:
    
Due to the small number of studies in the comparison we are unable to conclude whether calcium-regulating agents are protective .
REVIEW ER 'S CONCLUSIONS Both danazol and progesterone + oestrogen add-back have been shown to be protective of BMD , while on treatment and up to six and 12 months later , respectively .