TOPLINE:

Hormonal suppression therapies for endometriosis, such as gonadotropin-releasing hormone (GnRH) agonists with add-back therapy, dienogest, and GnRH antagonists, were associated with reductions in bone mineral density at the lumbar spine after 6 and 12 months of treatment.

METHODOLOGY:

• Researchers conducted a systematic review and meta-analysis of 37 studies (28 randomized controlled trials, six prospective cohort studies, and three retrospective cohort studies) evaluating the effect of hormonal treatments for endometriosis on bone mineral density.
• Women of reproductive age received treatment for endometriosis for at least 6 months, including oral, transdermal, or injectable medications.
• Therapies spanned GnRH agonists with add-back therapy (estrogen-progestin combinations, progestin alone, or tibolone), antagonists at different dosing regimens, dienogest, and depot medroxyprogesterone acetate.
• The outcome measure was the percentage change in bone mineral density at the lumbar spine after 6 months of therapy and at 12 months.

TAKEAWAY:

• GnRH agonists with add-back therapy resulted in reduced bone mineral density at 6 months (mean, -0.89%; 95% CI, -1.45 to -0.33; I², 20.3%; 11 studies) and at 12 months (mean, -1.50%; 95% CI, -2.68 to -0.31; I², 40.5%; four studies).
• In subgroup analyses, leuprolide was associated with a reduction in bone mineral at 6 months (mean, -1.33%; 95% CI, -1.92 to -0.74; I², 0%; six studies).
• Dienogest was associated with decreases in bone mineral density at 6 months (mean, -0.83%; 95% CI, -1.52 to -0.15; I², 76.8%; six studies) and at 12 months (mean, -1.91%; 95% CI, -2.58 to -1.24; I², 83.7%; four studies).
• GnRH antagonists without add-back therapy demonstrated a 6‑month pooled change in bone mineral density of -2.17% (95% CI, -3.44 to -0.90; I², 97.3%; five studies).

IN PRACTICE:

“The data of this study will be helpful to clinicians when providing an overview of the potential effects of hormonal suppression for endometriosis on bone health,” the authors wrote.

SOURCE:

The study was led by Jade Desilets, MD, of the Department of Obstetrics & Gynecology at the Trillium Health Partners in Mississauga, Ontario, Canada. It was published online on March 19, 2026, in Obstetrics & Gynecology.

LIMITATIONS:

The number of publications for certain therapy types was small, and the heterogeneity in results was high. Bone mineral density recovery after treatment discontinuation was not examined.

DISCLOSURES:

The study did not report any specific funding. No relevant conflicts of interest were disclosed by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.