Balancing Catamenial Pneumothorax Management with Fertility: Insights from GnRH Agonist Use

BACKGROUND Catamenial pneumothorax (CP) is the most common manifestation of thoracic endometriosis syndrome, typically managed with hormonal therapy to suppress ovarian function and prevent recurrence. However, this approach conflicts with pregnancy planning, creating a therapeutic dilemma. While previous reports have discussed CP management, limited evidence exists on long-term strategies that balance disease control with fertility preservation. This case report discusses the use of a GnRH agonist as an alternative to conventional hormonal therapy, demonstrating its potential to delay CP progression while maintaining reproductive potential. CASE REPORT A 37-year-old woman, P0A0, presented with shortness of breath and a history of dysmenorrhea. A decade earlier, she had been diagnosed with pelvic endometriosis and a similar pneumothorax episode. She declined continuous hormonal therapy to preserve fertility and was instead treated with a gonadotropin-releasing hormone (GnRH) agonist. Ten years later, she developed CP and underwent pleurodesis with excision of endometriosis implants. Her postoperative course was uneventful, and she resumed pregnancy planning. This outcome aligns with emerging evidence suggesting that GnRH agonists offer prolonged CP control without compromising fertility, contrasting with the higher recurrence rates seen in patients who do not receive medical management. CONCLUSIONS This case demonstrates that prolonged CP control is feasible using a GnRH agonist, providing an alternative to continuous hormonal therapy in women prioritizing fertility. Future research should focus on defining the optimal duration of GnRH agonist treatment, identifying patient selection criteria, and evaluating long-term reproductive outcomes in CP patients who do not receive standard hormonal suppression.