Treatment of Uterine Leiomyomata by LH-RH Agonists
The rapid development and availability of luteinizing hormone releasing hormone (LH-RH) agonists have led to their widespread utilization in a variety of gynecologic conditions (McLachlan et al. 1986). One of the most common conditions in the practice of the gynecologist is uterine leiomyomata (Heinrichs 1991). Uterine leiomyomata are the most common solid tumor of the female genital tract and may bring about menometrorrhagia, pelvic pain and discomfort, anemia, infertility and habitual abortion (Blumenfeld et al. 1990; Esterday et al. 1983; Filicori et al 1983; Heinrichs 1991). Estrogens are known to play a major role in the development and enlargement of these tumors. High levels of estrogen receptors have been found in this type of tumor, and exogenous administration of estrogens may result in rapid increase in their size (Blumenfeld et al. 1990; Filicori et al. 1983; Heinrichs 1991; Tamaya et al. 1985; Wilson et al. 1980). The estrogen dependence is in agreement with the clinical observations that fibroids are most commonly diagnosed in women aged between 30 and 50 years, that fibroids tend to shrink after the menopause, and that fibroids can rapidly increase in size during pregnancy (Healy 1990). On the other hand, case-control analysis of 535 women who had had leiomyomata showed that the risk of leiomyomata was inversely correlated with the number of term pregnancies (Healy 1990; Ross et al. 1986). This suggested that low, unopposed estradiol (E2) levels, resulting from the several pregnancies and also the subsequent puerperia, reduced the growth of nascent leiomyomata (Healy 1990). The risk of developing leiomyomata was directly correlated with increasing duration of oral contraceptive use, lower body weight, and cigarette smoking (Healy 1990; Ross et al. 1986). Serum E2 concentrations in patients with uterine leiomyomata were similar to those in control women (Healy 1990; Soules and McCarthy 1982; Spellacy et al. 1972).
KeywordsUterine Fibroid Medroxyprogesterone Acetate GnRH Analogue LHRH Agonist Leuprolide Acetate
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- Benagiano G, Morini A, Abbondante A, Aleandri V, Piccinno F, Sala D (1990) Sequential buserelin — medroxyprogesterone acetate treatment of uterine leiomyomata. In: Vickery BH, Lunenfeld B (eds) GnRH analogues in cancer and human reproduction: III. Benign and malignant tumours. Kluwer, Dordrecht, pp 53–62CrossRefGoogle Scholar
- Blumenfeld Z, Dirnfeld M, Beck D, Abramovici H, Brandes JM (1990) Comparison of treatment of uterine leiomyomata with 3 different GnRH agonistic analogs. In: Vickery BH, Lunenfeld B (eds) GnRH analogues in cancer and human reproduction: III. Benign and malignant tumours. Kluwer, Dordrecht, pp 45–52CrossRefGoogle Scholar
- Blumenfeld Z, Thaler I, Weiner Z, Beck D, Brandes JM (1991) Treatment of uterine leiomyomata with GnRH analogue (Nafarelin): a clinical protocol of interrupted (on and off) treatment. In: Lunenfeld B (ed) GnRH Analogues. Parthenon, Park Ridge, pp 43–51Google Scholar
- Esterday CL, Grimes DA, Riggs JA (1983) Hysterectomy in the United States. Obstet Gynecol 62:203–220Google Scholar
- Filcori M, Hall DA, Laughlin JS, Rivier J, Vale W, Crowley WF (1983) A conservative approach to the management of uterine leiomyomata: pituitary desensitization by a luteinizing hormone releasing hormone analogue. Am J Obstet Gynecol 147:726–729Google Scholar
- Heinrichs WL (1991) Gonadotropin releasing-hormone agonists (GnRH-a) in gynecological practice: endometriosis and leiomyomata uteri. In: Mishell DR, Kirshbaum TH, Morrow CP (eds) Yearbook of obstetrics and gynecology. Mosby, St. Louis, p 333Google Scholar
- Van Leusden HAIM (1986) Rapid reduction of uterine myomas after short term treatment with microencapsulated D-Trp6-LH-RH. Lancet 1:213Google Scholar
- Van der Spuy ZM, Fieggan AG, Wood MJA, Pienaar CA (1989) The short-term use of luteinizing hormone-releasing hormone analogues in uterine fibroids. Horm Res [Suppl l]:137–140Google Scholar