Use of GnRH antagonists in the treatment of endometriosis.
Endometriosis is an oestrogen-dependent disease that is treatable by oestrogen withdrawal, a therapy that has been effectively provided by the use of a gonadotrophin-releasing hormone (GnRH) agonist. Complete oestrogen withdrawal results in unacceptable side-effects, in particular in accelerated bone density loss. This problem has been effectively overcome with 'add-back therapy' using low-dose oestrogens and progestins in combination with a GnRH agonist to limit these side-effects, while still allowing regression of endometriotic lesions. The aim of this study was to determine the feasibility of using a subcutaneous injection of GnRH antagonist in the treatment of endometriosis. All patients (15/15; 100%) reported a symptom-free period during GnRH antagonist treatment, including mood changes, hot flushes, loss of libido, vaginal dryness and other symptoms. Serum oestradiol oscillated around a mean concentration of 50 pg/ml during therapy. Diagnostic laparoscopy before GnRH antagonist administration showed a mean stage III of disease. Regression occurred in 60% of cases (9/15) and the degree of endometriosis declined to stage II. Sequential administration of the GnRH antagonist cetrorelix (Cetrotide) in a 3 mg dosage once weekly over 8 weeks creates a new opportunity for medical treatment of symptomatic endometriosis. Preserving basic oestrogen production during the course of treatment apparently does not influence regression of disease, and has no major side-effects.
Küpker
W
W
Department of Obstetrics and Gynaecology, Medical University Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany. wkupker@hotmail.com
Felberbaum
R E
RE
Krapp
M
M
Schill
T
T
Malik
E
E
Diedrich
K
K
D004715:Endometriosis / Q000188:drug therapy* / Q000473:pathology; D005240:Feasibility Studies; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000009:adverse effects / Q000031:analogs & derivatives / Q000037:antagonists & inhibitors* / Q000627:therapeutic use*; D006727:Hormone Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D006728:Hormones / Q000097:blood; D006801:Humans; D010865:Pilot Projects
D006727:Hormone Antagonists; D006728:Hormones; D007987:Gonadotropin-Releasing Hormone; C062876:cetrorelix