Low-dose GnRH agonist therapy for the management of endometriosis.
OBJECTIVE
In order to examine whether treatment with a GnRH agonist alone can maintain estrogen levels within the "estrogen window" that inhibits endometriosis without influencing bone-mineral density, we studied the effects of GnRH agonist therapy and changes in bone-mineral density.


METHODS
Buserelin acetate nasal spray was administered 3 times a day for 8 weeks (daily dose, 900 micrograms) to 21 women with endometriosis. The drug was then given twice a day for 16 weeks (daily dose, 600 micrograms). The total duration of treatment was 24 weeks. The bone-mineral density of the lumbar vertebrae was measured by dual-energy X-ray absorptiometry before treatment (baseline), at the end of treatment, and 24 weeks after the end of treatment.


RESULTS
The bone-mineral density of the lumbar vertebrae at the end of treatment was 2.44% +/- 0.46% (mean +/- standard error) lower than the baseline value. The value at 24 weeks after the end of treatment was 1.10% +/- 0.64% lower than the baseline value. More than 80% of the patients had serum-estradiol levels of 45 pg/ml or less. During treatment, more than 90% of the patients had serum-estradiol levels of 60 pg/ml or less. Genital bleeding was inhibited in 90% of the patients. After 8 weeks of treatment, the clinical symptoms improved in 75% of the patients; such improvement persisted for the duration of the treatment.


CONCLUSIONS
Decreasing the dose of GnRH agonist during treatment can minimize the loss of bone-mineral density without lessening the beneficial effects on endometriosis. This technique might be useful in the management of endometriosis.
Uemura
T
T
Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Japan.
Shirasu
K
K
Katagiri
N
N
Asukai
K
K
Suzuki
T
T
Suzuki
N
N
Osada
H
H
Hiroshi
M
M
D015746:Abdominal Pain; D015502:Absorptiometry, Photon; D000281:Administration, Intranasal; D000328:Adult; D015519:Bone Density; D002064:Buserelin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004715:Endometriosis / Q000188:drug therapy*; D004958:Estradiol / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D008159:Lumbar Vertebrae; D007986:Luteinizing Hormone / Q000097:blood; D008875:Middle Aged
D004958:Estradiol; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D002064:Buserelin