goserelin and Metrorrhagia

To study the effectiveness and safety of combined laparoscopy and gonadotropin-releasing hormone agonist (GnRH-a) in the treatment of endometriosis (EM).. From January to December 2010, 198 patients with EM undergoing treatment in Department of Obstetrics and Gynecology, Beijing Anzhen Hospital were randomly divided into three groups, which include 52 cases treated by only laparoscopy in laparoscopy group; 76 cases treated by laparoscopy combined with domestic Leuprolide acetate with dose of 3.75 mg every 28 days in Leuprolide acetate group; 70 cases treated by laparoscopy combined with imported Goserelin acetate with dose of 3.6 mg every 28 days in Goserelin acetate group. The efficacy, pregnancy rate and adverse reactions were compared among the three groups.. Thirteen cases lost following up, including 3 cases in laparoscopy group, 6 cases in Leuprolide acetate group and 4 cases in Goserelin acetate group. (1) Effective rates: effective rates were 47% (23/49) in laparoscopy group, 77% (54/70) in Leuprolide acetate group and 74% (49/66) in Goserelin acetate group. Compared with laparoscopy group, the effective rate of Leuprolide acetate group and Goserelin acetate group was significantly elevated (P < 0.05). There was no statistically significant difference between Leuprolide acetate group and Goserelin acetate group (P > 0.05).(2) Recurrence rate: recurrence rate were 33% (16/49) in laparoscopy group, 13% (9/70) in Leuprolide acetate group and 12% (8/66) in Goserelin acetate group. Compared with laparoscopy group, the recurrence rate of Leuprolide acetate group and Goserelin acetate group was significantly declined (P < 0.05). There was no statistically significant difference between Leuprolide acetate group and Goserelin acetate group (P > 0.05). (3) Pregnancy rate: the number of patients require fertility were 28 cases in laparoscopy group, 39 cases in Leuprolide acetate group and 35 cases in Goserelin acetate group. After 2 years follow up, pregnancy rate of 62% (24/39) in Leuprolide acetate group and 60% (21/35) in Goserelin acetate group were high than 39% (11/28) in laparoscopy group significantly, which did not reached significant difference (P > 0.05). (4) Adverse drug reaction:rates of a adverse reactions were 21% (15/70) in Leuprolide acetate group and 20% (13/66) in Goserelin acetate group, including irregular vaginal bleeding associated with low estrogen level. There was no significant difference in adverse reactions (P > 0.05).. Compared with laparoscopy alone, laparoscopy combined with GnRH-a is more effective in treatment of, which exhibit lower recurrence rate, higher pregnancy rate and fewer adverse reactions. Domestic Leuprolide acetate have similar safety and efficacy compared with imported GnRH-a.

Topics: Adult; Electrocoagulation; Endometriosis; Female; Gonadotropin-Releasing Hormone; Goserelin; Humans; Injections, Subcutaneous; Laparoscopy; Leuprolide; Metrorrhagia; Pregnancy; Pregnancy Rate; Treatment Outcome; Young Adult

To assess the effects of adding combined estradiol/norethisterone acetate therapy (CENT) to goserelin acetate treatment (GA) of dysfunctional uterine bleeding (DUB) in perimenopausal women.. In a randomized, placebo-controlled, double-blind trial followed by an open follow-up study, 31 perimenopausal women with DUB were recruited from gynecological outpatient departments of two Dutch hospitals and randomized for treatment with either GA/placebo or GA/CENT for 6 months followed by 18 months of GA/CENT for all. The main outcome measures were abdominal pain, number of bleeding days, double-layer endometrial thickness (DET), Greene climacteric score (GCS), visual analog scale for well-being, bone mineral density (BMD) and mammographic density (BI-RAD score).. Abdominal pain, number of bleeding days and DET decreased in both groups, the between-group difference in decrease not being statistically significant. GCS initially showed significant improvement in the GA/CENT group. BMD decreased significantly in the GA/placebo group (-4.1%) compared with the GA/CENT group (-0.3%). Another 18 months of GA/CENT did not result in a lasting difference in BMD between groups. BI-RAD scores did not differ significantly between or within the two groups.. Adding CENT to GA treatment for DUB in perimenopausal women initially prevented BMD loss and improved climacteric complaints, while having no negative impact on vaginal bleeding, abdominal pain or BI-RAD scores. However, prolonged treatment did not result in a lasting prevention of bone loss.

Topics: Antineoplastic Agents, Hormonal; Bone Density; Climacteric; Double-Blind Method; Drug Combinations; Estradiol; Female; Goserelin; Hormone Replacement Therapy; Humans; Mammography; Metrorrhagia; Middle Aged; Norethindrone; Perimenopause

STUDY-PLAN: an open study aimed at evaluating the results of a short term therapy (3 months) with Goserelin depot as a medical treatment of premenopausal dysfunctional uterine bleeding.. 60 premenopausal women (aged 36-50) with dysfunctional uterine bleeding, presenting simple endometrial hyperplasia.. after the treatment, spontaneous menstrual bleeding recurred in 57/60 patients, while 3/60 (5%) patients remained amenorrheal during the whole period of follow-up, showing a postmenopausal hormonal pattern. In the first post-therapy menstrual cycle all the 57 patients had a bleeding score < 100; patients relapsing during the second, third and fourth cycle were respectively 2/54 (3.7%), 5/48 (10.7%) and 17/38 (44.7%). The fourth post-therapy cycle was delayed 6-9 months after the last injection of Goserelin. Both the mean blood loss and the mean duration of bleeding were significantly reduced in all post-therapy cycles. Eleven patients were anaemic before therapy (Hb < 12 g%); Goserelin treatment resulted in a normalization of the hematological parameters. At the end of treatment a small area of hyperplasia persisted in only 4/60 patients (6.7%). Localised or diffused hyperplasia were found respectively in 5/54 (9.3%) and in 1/54 patients (1.9%) at three months, and in 5/48 (10.4%) and 4/48 (8.3%) at a six-month follow-up. Side effects were infrequent.. the long symptom-free period and the low incidence of side effects indicates Goserelin depot as a valuable medical treatment for dysfunctional uterine bleeding.

Topics: Adult; Delayed-Action Preparations; Dose-Response Relationship, Drug; Endometrial Hyperplasia; Female; Goserelin; Humans; Menorrhagia; Metrorrhagia; Middle Aged; Premenopause

Cyclic or irregular uterine bleeding is common in perimenarchal and perimenopausal women with or without endometrial hyperplasia. The disturbance often requires surgical treatment because of its negative effects on both blood loss and abnormal endometrial growth including the development of endometrial cancer. The endometrium is often overstimulated during the perimenopausal period when estrogen/progesterone production is unbalanced. A therapeutical approach with gonadotropin-releasing hormone agonist (GnRHa) was proposed in a depot formulation (Zoladex) that induces a sustained and reversible ovarian suppression. To avoid the risk of osteoporosis and to obtain adequate endometrial proliferation and differentiation during ovarian suppression, transdermal 17-beta-estradiol and oral progestin were administered. Results of 20 cases versus 20 controls showed a reduction of metrorrhagia, a normalization of hemoglobin plasma concentration, and an adequate proliferation and secretory differentiation of the endometrium of patients with abnormal endometrial growth. Abnormal uterine bleeding is mainly due to uterine fibrosis and an inadequate estrogen and/or progesterone production or to a disordered estrogen transport from blood into the endometrium. In premenopausal women, endometrial hyperplasia may be part of a continuum that is ultimately manifested in the histological and biological pattern of endometrial carcinoma. The regression of endometrial hyperplasia obtained by using the therapeutic regimen mentioned above represents a preventive measure for endometrial cancer. Finally the normalization of blood loss offers a good medical alternative to surgery for patients with DUB.

Topics: Adult; Delayed-Action Preparations; Endometrial Hyperplasia; Endometrium; Estradiol; Female; Follicle Stimulating Hormone; Goserelin; Humans; Laminin; Luteinizing Hormone; Metrorrhagia; Middle Aged; Progesterone

Glandular Hyperplasia is commonly associated with meno and/or metrorrhagia. We treated 84 patients suffering from meno and/or metrorrhagia associated with simple glandular hyperplasia with a gonadotropin releasing hormone agonist, goserelin, (Zoladex, ICI Pharmaceuticals, Macclesfield. Cheshire, England), available in a depot formulation. Subcutaneous administration of goserelin 3.6 mg was repeated every 28 days for 6 months. Within the first 4 weeks from the start of therapy 45% of the patients became amenorrhoeic, within 12 weeks 100%. Only 3 patients reported continued spotting. Hysteroscopic evaluation and biopsy have shown in the 84 evaluable patients, a positive result in 76 (90.4%), demonstrating the validity of the use of this analogue in this indication. In the future it would be of value to increase the period of treatment in selected cases as well as increasing the length of the follow-up period.

Topics: Adult; Delayed-Action Preparations; Endometrial Hyperplasia; Female; Follow-Up Studies; Goserelin; Humans; Hysteroscopy; Injections, Subcutaneous; Menorrhagia; Metrorrhagia; Middle Aged; Uterus

Nineteen patients with simple endometrial hyperplasia presenting metrorrhagia or menometrorrhagia were treated with 4 injections of Goserelin depot, one every 4 weeks. 12/19 patients were refractory after previous medical therapy. The treatment with Goserelin depot resulted in a complete remission of the symptoms, occurring within the first month of treatment and still present after a median follow-up of 12 months, and in the normalization of the histological profile. No patient experienced clinically relevant side effects.

Topics: Biopsy; Delayed-Action Preparations; Endometrial Hyperplasia; Endometrium; Female; Goserelin; Humans; Menorrhagia; Metrorrhagia