LHRH analogues in the management of uterine fibroids, premenstrual syndrome and breast malignancies.
Agonist analogues of LHRH are of potential value in the management of oestrogen-dependent conditions in women. However, their clinical effectiveness is a direct consequence of ovarian suppression which is in itself associated with adverse effects, in particular loss of bone mass. They are thus unsuitable for long-term use in premenopausal women with benign conditions but in future may have a wider role in combination with other agents. In women with uterine fibroids, therapy leads to reduction of uterine volume and alleviation of symptoms although the benefit is rapidly reversed when therapy ceases. Although there is a theoretical potential for combined therapy, successful combinations have yet to be identified. Thus, at the present time, agonists of LHRH do not offer a true alternative to surgery for the majority of women. They will be of value where there is a contra-indication to surgery and for women approaching the age of the natural menopause. They may also be of use prior to surgery, both in controlling symptoms and in reducing surgical morbidity and blood loss. LHRH agonists appear to be beneficial in the management of some women with severe premenstrual tension but intensify symptoms in others. Particular care is required in selection of women for such therapy because of the uncertain nature of the condition and its high rate of response to placebo therapy. Response is dependent on the degree of ovarian suppression and long-term use of LHRH agonists alone is clearly undesirable. However LHRH agonists alone or in combination with ovarian steroids are of potential value as a research tool. In premenopausal women with advanced breast cancer, concerns about the long-term effects of therapy with LHRH agonists are less important and these drugs offer a medical alternative to oophorectomy as first-line treatment in women with oestrogen receptor-positive tumours. Future developments are likely to include evaluation of combined therapy and comparative studies in women with early disease. As such studies involve long-term treatment, they will generate very useful information about the effects of therapy. This will be of great value to clinicians evaluating the role of LHRH agonists in the management of benign conditions.
West
C P
CP
D001943:Breast Neoplasms / Q000188:drug therapy*; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D007889:Leiomyoma / Q000175:diagnosis / Q000188:drug therapy*; D010051:Ovarian Neoplasms / Q000188:drug therapy*; D014594:Uterine Neoplasms / Q000175:diagnosis / Q000188:drug therapy*
D007987:Gonadotropin-Releasing Hormone