Two-step gonadotropin-releasing hormone agonist treatment of uterine leiomyomas: standard-dose therapy followed by reduced-dose therapy.
OBJECTIVE
Gonadotropin-releasing hormone agonist-induced partial pituitary suppression with low-grade estrogen production may be useful in long-term treatment of uterine leiomyomas.


METHODS
Twenty-seven women with uterine leiomyomas were treated with a standard dose of triptorelin for 8 weeks. Patients were then randomized to use 100, 20, or 5 micrograms of triptorelin until week 26. Uterine and myoma size, pituitary-ovarian function, bone metabolism, and bone mineral density were monitored.


RESULTS
During standard treatment uterine size was reduced to 67.1% of baseline. During randomized treatment uterine size was further reduced to 57.8% of baseline. There were no differences in overall volume reduction among the groups. Luteinizing hormone and estradiol levels were restored in a dose-dependent way. Bone mineral density decreased significantly in the highest-dose group at week 26.


CONCLUSIONS
This study shows that the beneficial effects of initial high-dose agonist treatment on uterine leiomyomas can be preserved by continued low-dose treatment. Bone mineral density does not seem to change during reduced-dose agonist treatment.
Broekmans
F J
FJ
Division of Reproductive Endocrinology and Fertility, Vrije Universiteit, Amsterdam, The Netherlands.
Hompes
P G
PG
Heitbrink
M A
MA
Netelenbos
C C
CC
Roos
J C
JC
Falke
T M
TM
Schoemaker
J
J
D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage*; D015519:Bone Density; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007889:Leiomyoma / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D007986:Luteinizing Hormone / Q000097:blood; D017329:Triptorelin Pamoate / Q000008:administration & dosage*; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology
D018931:Antineoplastic Agents, Hormonal; D017329:Triptorelin Pamoate; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone