Efficacy and safety considerations in women with uterine leiomyomas treated with gonadotropin-releasing hormone agonists: the estrogen threshold hypothesis.
Gonadotropin-releasing hormone agonists induce a reversible hypogonadotropic hypogonadal environment. Leiomyomas are common, estrogen-sensitive, benign neoplasms that decrease in size by 40% to 50% during gonadotropin-releasing hormone agonist treatment. During gonadotropin-releasing hormone agonist therapy most women are amenorrheic. After discontinuation of gonadotropin-releasing hormone agonist treatment, uterine and myoma size increase and a return to pretreatment menstrual patterns often occurs. Concerns about the safety of long-term hypoestrogenism have made long-term gonadotropin-releasing hormone agonist administration an undesirable treatment strategy. This article focuses on the use of gonadotropin-releasing hormone agonists as preoperative therapy in selected women undergoing hysterectomy or myomectomy and the combination of a gonadotropin-releasing hormone agonist with estrogen-progestin "add-back" treatment as a potential long-term medical therapy for women with symptomatic leiomyomas. Finally, an estrogen threshold hypothesis to assess the effects of circulating estrogen concentrations on different tissues, is presented.
Friedman
A J
AJ
Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA 02115.
Lobel
S M
SM
Rein
M S
MS
Barbieri
R L
RL
D002064:Buserelin / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use*; D004958:Estradiol / Q000097:blood; D004967:Estrogens / Q000097:blood* / Q000627:therapeutic use; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D017273:Goserelin; D006801:Humans; D007889:Leiomyoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D016729:Leuprolide; D008875:Middle Aged; D010865:Pilot Projects; D011300:Preoperative Care; D011372:Progestins / Q000627:therapeutic use; D013997:Time Factors; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D014599:Uterus / Q000473:pathology
D004967:Estrogens; D011372:Progestins; D017273:Goserelin; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol; D016729:Leuprolide; D002064:Buserelin