Treatment of Uterine Leiomyomata by LH-RH Agonists

Abstract

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).