goserelin and Chronic-Disease

To compare efficacy of the levonorgestrel-releasing intrauterine system (LNG-IUS; Mirena) with depot GnRH analogue (GnRH-a; gosareline acetate; Zoladex) on endometriosis-related chronic pelvic pain (CPP) in patients with severe endometriosis during 12 months.. Prospective, randomized, controlled study.. The reproductive endocrinology unit of a tertiary, research and education hospital.. Forty women with severe endometriosis (revised The American Fertility Society [AFS] classification >40) and endometriosis-related CPP and control groups were enrolled in the study.. The patients were treated with either LNG-IUS (n = 20) or GnRH-a (n = 20). The GnRH-a dose was repeated every 4 weeks for 24 weeks.. Scores of CPP were evaluated using a visual analogue scale (VAS) and total endometriosis severity profile (TESP).. The TESP score decreased in the LNG-IUS group at first, third, and sixth month follow-up visits, whereas at the 12th month follow-up visit, the TESP scores were increased to values similar to pretreatment values. Although the VAS score had no significant alteration during the follow-up period in the LNG-IUS group, the GnRH-a group showed a significant decrease in the VAS score and TESP score at the end of 1 year. The LNG-IUS treatment showed a lower patient satisfaction.. Both treatment modalities showed comparable effectiveness in the treatment of CPP-related endometriosis.

Topics: Adult; Chronic Disease; Delayed-Action Preparations; Endometriosis; Female; Fertility Agents, Female; Follow-Up Studies; Gonadotropin-Releasing Hormone; Goserelin; Gynecologic Surgical Procedures; Humans; Intrauterine Devices, Medicated; Levonorgestrel; Pain, Postoperative; Pelvic Pain; Treatment Outcome; Uterine Diseases

To assess the safety and efficacy of long-term use of long-acting GnRH agonist in women with chronic cyclical pelvic pain using immediate versus delayed add-back hormonal replacement therapy (HRT).. A prospective randomised trial.. Reproductive and Developmental Medicine, Academic Unit, University Teaching Hospital and NHS Hospitals.. Thirty-eight premenopausal women with chronic cyclical pelvic pain were recruited.. Women were given Zoladex 10.8 mg over 18 months and randomised to receive HRT (tibolone 2.5 mg) either immediately or after 6 months. Follow up was 12-month post-treatment.. Bone mineral density at 6 months, the end of treatment (18 months), and 12 months later, pain and quality of life.. Women treated with immediate HRT add-back showed less bone mineral density loss at 6 months and less vasomotor symptoms compared with those who had delayed HRT add-back treatment. Long-term follow up showed both groups experienced equivalent bone mineral density loss. Pain and health-related quality-of-life assessment showed improvement in both groups but there was evidence of a return to baseline levels after ending treatment.. Long-term use of GnRH agonist plus immediate add-back HRT is a safe and acceptable approach to intractable cyclical pelvic pain. Given the delay in reactivation of the hypothalamo-pituitary-ovarian axis after long-term suppression, an intermittent dose regime with GnRH agonist might warrant investigation.

Topics: Adult; Bone Density; Chronic Disease; Drug Administration Schedule; Drug Therapy, Combination; Estrogen Replacement Therapy; Female; Follow-Up Studies; Gonadotropin-Releasing Hormone; Goserelin; Humans; Middle Aged; Norpregnenes; Pain Measurement; Pelvic Pain; Premenopause; Quality of Life; Treatment Outcome; Young Adult

Following identification of the proportion of pelvic congestion among symptomatic patients complaining of chronic pelvic pain, and in a totally asymptomatic group of patients requesting tubal ligation, the efficiency of goserelin acetate versus medroxyprogesterone acetate was compared objectively using pelvic venogram scores, and subjectively by symptom resolution, improvement of psychological status and sexual functioning in a prospective randomized trial in 47 patients with pure pelvic congestion syndrome. Patients received either goserelin acetate (3.6 mg/month for 6 months) or medroxyprogesterone acetate (MPA; 30 mg/day for 6 months). Among patients with chronic pelvic pain, those with pure pelvic congestion were mostly parous, had the most severe pelvic signs and symptom scores, lowest rates of sexual functioning, and higher states of anxiety and depression as compared with others. At 1 year after treatment, goserelin remained superior to MPA in terms of pelvic venographic improvement as an objective measure. In alleviation of signs and symptomatology, improvement of sexual functioning and reduction of anxiety and depressive states as subjective measures, goserelin acetate achieved a statistically significant advantage (P = 0.0001) compared with MPA.

Topics: Adnexal Diseases; Anxiety; Chronic Disease; Depression; Female; Goserelin; Humans; Medroxyprogesterone Acetate; Pelvic Pain; Pelvis; Phlebography; Prospective Studies; Sexual Dysfunction, Physiological

To assess whether suppression of ovarian function by a gonadotrophin releasing hormone (GnRH) analogue could assist in the diagnosis of chronic pelvic pain in women with residual ovaries.. Uncontrolled, observational study.. District general hospital (seven women) and teaching hospital (one woman).. Eight women with residual ovaries and chronic pelvic pain.. Goserelin 3.6 mg every 28 days was used followed by surgery to remove residual ovaries.. The women's response to goserelin and surgery (12 months or more post-operatively) was assessed clinically. RESULTS. Goserelin was associated with resolution of pelvic pain in the six women who obtained relief of pain with oophorectomy. The only woman who did not respond to goserelin also failed to gain relief with surgery. One woman who responded to goserelin declined surgery.. Suppression of ovarian function by GnRH analogues may allow differentiation of pelvic pain caused by the residual ovary syndrome from other causes. This would enable selection of cases likely to benefit from surgery, avoiding potentially difficult surgery in women who will gain little or no relief of symptoms with surgery. Only eight cases are reported and a randomised controlled trial would be required to determine the place of GnRH agonists in the treatment of the residual ovary syndrome.

Topics: Adult; Chronic Disease; Female; Follow-Up Studies; Goserelin; Humans; Hysterectomy; Middle Aged; Ovarian Diseases; Ovariectomy; Pain, Postoperative; Pelvic Pain

A 23-year-old, regularly menstruating woman presented with recurrent urticarial eruptions, which occurred premenstrually. A skin prick test was positive for progesterone, but the urticaria was unresponsive to standard treatments. The patient was treated with goserelin (Zoladex), which suppressed her menstrual cycle, leading to the resolution of her symptoms. Subsequent flares were controlled by further goserelin injections, and the urticaria is currently in remission. However, the risks of inducing menopause artificially are significant, and alternative long-term solutions may need to be considered in the event of a relapse.

Topics: Autoimmune Diseases; Chronic Disease; Female; Goserelin; Humans; Progesterone; Treatment Outcome; Urticaria; Young Adult

To assess whether GnRH analogues are effective in relieving pelvic pain and congestion and whether menopausal symptoms caused by GnRH analogues can be minimised by supplementation with low dose continuous combined hormone replacement therapy (HRT).. Open prospective study.. Tertiary referral clinic at a teaching hospital.. Twenty-one women with chronic pelvic pain.. Four months' therapy with goserelin 3.6 mg/month combined with continuous oestradiol valerate 1 mg daily and medroxyprogesterone acetate 5 mg daily.. Visual analogue scale for pain, menopausal symptoms, bleeding patterns, uterine area, endometrial status, oestradiol concentrations and venogram scores.. Amenorrhoea was maintained in all but two women. Endometrial atrophy was maintained despite HRT supplementation. Two women had moderate menopausal symptoms but none had severe symptoms. Significant reduction of uterine cross sectional area was maintained throughout the study. There was no significant relief of pain.. HRT supplementation of GnRH analogues abolishes menopausal symptoms and thus may improve patient acceptability. Potentially beneficial effects such as endometrial atrophy, reduction of uterine volume and amenorrhoea were not negated by HRT. This combination is not effective in the treatment of chronic pelvic pain and congestion.

Topics: Adult; Chronic Disease; Estradiol; Estrogen Replacement Therapy; Female; Goserelin; Humans; Hysterectomy; Medroxyprogesterone Acetate; Menopause; Pain Measurement; Patient Satisfaction; Pelvic Inflammatory Disease; Prospective Studies; Time Factors

Thirty-one patients with retention of urine and carcinoma of the prostate were treated with LHRH analogues as primary therapy rather than prostatectomy; 21 patients voided without the need for surgical intervention. Patients presenting in acute retention of urine voided more readily than those presenting in chronic retention, with only 20% requiring surgery. This approach to treatment is safe, efficacious and cost effective.

Topics: Acute Disease; Aged; Chronic Disease; Goserelin; Humans; Male; Prostate; Prostatic Neoplasms; Urinary Retention; Urination