goserelin and Premenstrual-Syndrome

Topics: Adjuvants, Pharmaceutic; Adult; Antineoplastic Agents, Hormonal; Drug Therapy, Combination; Endometriosis; Female; Gonadotropin-Releasing Hormone; Goserelin; Humans; Leiomyoma; Premenstrual Syndrome; Uterine Hemorrhage

The study aimed to determine if the addition of daily low-dose oral estrogen with a cyclical progestogen given to young women using a depot gonadotropin-releasing hormone (GnRH) analog implant for the treatment of their premenstrual syndrome (PMS) would affect the clinical outcome. In a double-blind placebo-controlled study in a specialist premenstrual syndrome clinic setting, 60 women aged between 20 and 45 years were randomized to one of three treatment groups: Group A (placebo implant four weekly + placebo tablets daily), Group B (goserelin 3.6 mg implant four weekly + estradiol valerate 2 mg daily with norethisterone 5 mg from days 21-28 of a 28-day cycle) or Group C (goserelin 3.6 mg implant four weekly + placebo tablets daily). Differences between PMS scores at 2, 4 and 6 months were compared with pretreatment values. There was a significant improvement in PMS scores in Group C (Zoladex + placebo) after 2, 4 and 6 months of treatment when compared to pretreatment values and Group A (placebo + placebo). The addition of a low-dose oral estrogen with a cyclical progestogen to GnRH analog treatment (Group B) resulted in a less dramatic response when compared to pretreatment values and no significant improvement when compared to Group A (placebo + placebo) at 2, 4 and 6 months of treatment. The addition of a low-dose oral estrogen with a cyclical progestogen to depot GnRH analog therapy in the treatment of PMS reduces the clinical response.

Topics: Administration, Oral; Adult; Delayed-Action Preparations; Double-Blind Method; Drug Therapy, Combination; Estradiol; Estrogen Replacement Therapy; Female; Goserelin; Humans; Middle Aged; Norethindrone; Premenstrual Syndrome; Progesterone Congeners; Surveys and Questionnaires

The usefulness of the gonadotrophin-releasing hormone (GnRH) agonists in treating benign chronic gynaecological disorders, such as endometriosis and uterine fibroids, or pre-menstrual syndrome (PMS), is limited by their hypo-oestrogenic side effects, including bone demineralisation and vasomotor symptoms. Studies in patients receiving GnRH agonists and hormone replacement therapy (HRT) show that whilst the efficacy of GnRH agonist monotherapy in treating endometriosis and fibroids is maintained, the concomitant add-back HRT can prevent the bone loss and reduce the incidence and severity of vasomotor symptoms. However, in a study of add-back HRT (an oestrogenic plus a progestogenic agent) in severe PMS, although the efficacy of Zoladex (goserelin acetate) against oestrogen-responsive symptoms, such as mood, was still evident, progestogenic side effects still occurred. It is likely that add-back HRT may need to be tailored to individual indications.

Topics: Adult; Bone Density; Double-Blind Method; Endometriosis; Estrogen Replacement Therapy; Female; Goserelin; Humans; Middle Aged; Premenstrual Syndrome; Treatment Outcome

The objective of this study was to determine the effectiveness of ovarian suppression by a GnRH agonist analogue in 32 women with prospectively confirmed severe premenstrual tension. The design was a randomized, double-blind study comparing goserelin 3.6 mg with placebo, both given as a monthly s.c. injection for 3 months. Self-assessment was by daily visual analogue scales (VAS) for anxiety and depression, daily quantitative symptom rating for breast discomfort, swelling, irritability, tension, depression and by monthly Hospital Anxiety and Depression (HAD) scales. Of the 16 women in each group, 15 completed active and 12 completed placebo therapy. Median symptom scores for whole cycles showed a significant reduction of breast discomfort and swelling during active treatment, with no significant improvement in psychological symptoms. Analysis by cycle phase showed that for individual subjects, pre-treatment differences in VAS scores for anxiety and depression were abolished in a significantly greater proportion of actively treated cycles. Within-group comparisons showed a marked placebo effect and, comparing the two groups, differences reached significance only during treatment cycle 1 and the first post-treatment cycle for anxiety with no significant differences for depression. It was concluded that while suppression of ovarian activity with a gonadotrophin-releasing hormone analogue dampens down cyclical mood swings, it has a more marked effect on the physical components of the premenstrual syndrome. Results reconfirm the positive role of placebo in the management of this condition.

Topics: Adult; Double-Blind Method; Female; Goserelin; Humans; Middle Aged; Ovary; Premenstrual Syndrome; Prospective Studies; Self-Assessment

To determine whether the addition of a low dose of oral estrogen replacement therapy (ERT) taken daily can prevent the bone loss associated with continuous GnRH analogue use.. In a double-blind, placebo-controlled study, 60 women aged 21-45 years were randomized to one of three treatment groups: placebo implant every 4 weeks plus placebo ERT tablets daily, Zoladex (goserelin 3.6 mg) implant every 4 weeks plus placebo ERT tablets daily, or Zoladex (3.6 mg) implant every 4 weeks plus estradiol valerate, 2 mg/day, with norethisterone 5 mg from days 22-28. A dual x-ray bone density scan was performed before treatment and again after six treatment cycles. The percentage bone change with respect to the initial bone density was calculated.. There was a significant loss of bone density at both the lumbar spine and proximal femur in the group receiving Zoladex plus placebo after 6 months compared with both pre-treatment values and with the group receiving placebo plus placebo. The addition of estrogen "add-back" therapy to GnRH analogue treatment (Zoladex plus ERT) resulted in no significant change in bone density compared with either pre-treatment values or the group receiving placebo plus placebo. The study had a dropout rate of 32%.. The addition of "add-back" estrogen therapy to continuous GnRH analogue use can prevent bone loss.

Topics: Administration, Oral; Adult; Bone Density; Double-Blind Method; Drug Implants; Estradiol; Estrogens; Female; Goserelin; Humans; Middle Aged; Norethindrone; Osteoporosis; Premenstrual Syndrome

The study was an audit of patients who attended the Menstrual Disorders Clinic at Glasgow Royal Infirmary over a five year period, and received gonadotrophin-releasing hormone analog (GnRHa). We aimed to identify the clinical indications for the use of GnRHa, and the effect of the latter in terms of symptom resolution and ultimate outcome. We aim to use this information to formulate a strategy for the use of GnRHa by targeting this expensive therapy to those situations where maximum benefit will be achieved.. A retrospective case review analysis of 201 patients.. Thirty-eight percent of women presented with pelvic pain, 33% with disordered menstruation and 26% with premenstrual symptomatology. Overall, 74% of patients reported a beneficial effect of GnRHa. In the non-cyclical pelvic pain group, those patients with adhesions constituted a much greater proportion of those who did not derive benefit from GnRHa than those who did (43% vs. 16%; p<0.05; data not shown). In those patients with disordered menses, there was no difference between the diagnosis in those who did or did not derive benefit from GnRHa. Also with the exception of endometrial preparation prior to ablation and in the correction of anemia, the ultimate outcome was no different in the two groups. Of the patients with premenstrual symptomatology, the greatest proportion of those deriving benefit from GnRHa (41%) ultimately had an operative resolution.. Our results enable us to use GnRHa as a first line in those clinical situations where maximum benefit will be achieved, either in terms of symptom resolution or as a tool to identify the most appropriate therapeutic option. We can therefore rationalize our prescribing both to the benefit of the patient and to our budget.

Topics: Adult; Cost-Benefit Analysis; Drug Utilization; Female; Goserelin; Humans; Menstruation Disturbances; Pelvic Pain; Premenstrual Syndrome; Retrospective Studies

Premenstrual exacerbation of asthma, as reflected by a reduction in peak expiratory flow rate (PEFR), has been demonstrated in 40-100% of female asthmatics. Epidemiological data demonstrate that admission to hospital with an exacerbation of asthma occurs more frequently perimenstrually. Therapeutic interventions aimed at modifying this precipitating factor, however, remain limited. We report on a 32-yr old female with asthma in whom a marked increase in symptoms and reduction in PEFR occurred premenstrually, necessitating recurrent admissions to hospital. Frequent severe exacerbations resulted in the chronic use of oral maintenance corticosteroids. In order to suppress gonadotrophin secretion and ovarian function, a long-acting gonadotrophin-releasing hormone analogue was administered with a view to inducing a reversible menopause. This resulted in improvement in respiratory symptoms, the absence of PEFR dips premenstrually, a reduction in maintenance prednisolone dosage and no further hospital admissions during a follow-up period of 14 months. The authors propose that gonadotrophin-releasing hormone-analogue therapy is a rational and innovative adjuvant treatment worthy of further study in cases of severe premenstrual asthma.

Topics: Adult; Anti-Asthmatic Agents; Asthma; Drug Therapy, Combination; Female; Follow-Up Studies; Goserelin; Humans; Peak Expiratory Flow Rate; Premenstrual Syndrome

The daily mood symptoms of four women with the premenstrual syndrome (PMS) were recorded before, and after spontaneous or induced ovarian failure. Response was assessed by iterative spectral analysis and the results compared with techniques based on changes in the mean or median mood score, or the measurement of premenstrual tension in arbitrary 'menstrual' cycles. Only iterative spectral analysis had the capacity to establish the significance of a change in symptom cyclicity, an important attribute for a condition such as the PMS.

Topics: Adult; Affect; Female; Fourier Analysis; Gonadal Steroid Hormones; Goserelin; Humans; Hysterectomy; Menopause; Menstrual Cycle; Middle Aged; Ovariectomy; Premenstrual Syndrome

Topics: Adult; Bone Density; Female; Femur Neck; Goserelin; Humans; Lumbar Vertebrae; Mastitis; Middle Aged; Premenstrual Syndrome; Randomized Controlled Trials as Topic

Topics: Anti-Inflammatory Agents, Non-Steroidal; Breast Diseases; Bromocriptine; Danazol; Fatty Acids, Essential; Female; gamma-Linolenic Acid; Goserelin; Humans; Linoleic Acids; Oenothera biennis; Pain; Periodicity; Plant Oils; Premenstrual Syndrome; Tamoxifen