goserelin and Uterine-Diseases

To compare the efficacy of aromatase inhibitor vs. gonadotrophin-releasing hormone agonists in treating premenopausal women with uterine adenomyosis.. A prospective randomized controlled study.. A university hospital and a private practice setting.. Thirty-two patients with uterine adenomyosis.. Patients were randomly allocated to receive oral letrozole (2.5 mg/day) or a subcutaneous gonadotropin-releasing hormone agonist (goserelin, 3.6 mg) for 12 weeks. Uterine and adenomyoma volumes were determined at baseline and during treatment at four, eight and 12 weeks.. Measurements were performed at baseline and during treatment at four, eight 8 and 12 weeks, and mean values were calculated. Symptoms at the start and after 12 weeks were evaluated.. No significant differences in the total uterine size between the post treatment uterine volumes in the two groups (20.1, 15.4 and 13.0 cm(3) vs. 21.7, 15.1 and 11.7 cm(3) , at four, eight and 12 weeks, respectively). Total adenomyoma volume decreased by 8.6, 29.7 and 40.9% vs. 5.7, 34.6 and 49.1% after four, eight and 12 weeks of treatment, in group A and B, respectively. Two patients became pregnant in group A during treatment.. Aromatase inhibitors are as effective as gonadotropin-releasing hormone agonists in reducing adenomyoma volume and improving symptoms.

Topics: Administration, Oral; Adolescent; Adult; Aromatase Inhibitors; Drug Administration Schedule; Endometriosis; Female; Fertility Preservation; Gonadotropin-Releasing Hormone; Goserelin; Humans; Injections, Subcutaneous; Letrozole; Nitriles; Premenopause; Single-Blind Method; Treatment Outcome; Triazoles; Uterine Diseases; Young Adult

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

The key enzyme in the biosynthesis of estradiol, aromatase, has been demonstrated within endometriosis. Combined administration of aromatase inhibitor and GnRH-agonist may efficiently suppress estrogen biosynthesis through a combined pituitary, ovarian, peripheral and "in situ" action. The aim of this study was to test the concept of combined down-regulation prior to IVF in patients with endometriomas.. Prospective pilot study in a university-based tertiary fertility clinic including 20 infertile patients with endometriomas undergoing IVF/ICSI. The patients received goserelin 3.6mg sc on treatment Days 1, 28 and 56, and one daily tablet of anastrozole 1mg from Day 1 to Day 69. Controlled ovarian stimulation was initiated from Day 70. Outcome measures were change in endometriomal volume and serum CA125 during down-regulation, standard IVF parameters including pregnancy and delivery rate, and endocrine response. The paired T test and Wilcoxon Signed Rank test were used to analyse paired differences.. During the combined down-regulation, the endometriomal volume and the serum CA125 level decreased by 29% (3-39%) and 61% (21-74%), respectively (median (95%CI), P=0.007 and P=0.001). In the IVF/ICSI cycle, the number of oocytes retrieved was 7.5 (6.0-10.0) and the fertilization rate was 0.78 (0.38-1.0). Nine patients (45%) conceived, five (25%) had a clinical pregnancy, and three (15%) delivered healthy children (two singletons and one twin).. Prolonged combined anastrozole and goserelin down-regulation significantly reduces endometriomal volume and serum CA125, and is compatible with IVF pregnancy and delivery. However, a high pregnancy loss was noted.

Topics: Adult; Anastrozole; Aromatase Inhibitors; CA-125 Antigen; Down-Regulation; Drug Therapy, Combination; Endometriosis; Estrogens; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Goserelin; Humans; Nitriles; Pilot Projects; Pregnancy; Pregnancy Outcome; Prospective Studies; Triazoles; Uterine Diseases

The effect of physical training on bone mineral density (BMD) in women with endometriosis treated with gonadotropin-releasing hormone (GnRH) analogs was studied.. Nineteen Caucasian premenopausal women aged 23-38 years were included in the study. The subjects were all treated with 21.6 mg goserelin during 6 months. The patients were randomized to physical training n=8 or to a control group n=11. The total period of training was 12 months, whereas GnRH treatment was terminated after 6 months. BMD was measured in the femoral neck area and the lumbar spine using dual X-ray absorptiometry (DEXA). This was performed just before treatment, after 6 months and after 12 months. Six women fulfilled the training during 12 months of observation. In the control group 10 women were followed up for 12 months.. After 6 months the women in the physical training group were 2.1% below baseline. Six months later these women had gained BMD in the femoral neck and were 0.6% below baseline. Those in the control group lost 2.8% after 6 months and were 3.6% below baseline after 12 months. The difference in loss of BMD after 12 months between the groups was significant 0.029. In the spine there was no significant difference between the two groups.. Physical training in women with endometriosis was found to rebuild bone after treatment with GnRH analogs when compared to a control group. This effect could be demonstrated 6 months after cessation of GnRH treatment.

Topics: Absorptiometry, Photon; Adult; Antineoplastic Agents, Hormonal; Bone Density; Endometriosis; Exercise; Female; Femur Neck; Follow-Up Studies; Goserelin; Humans; Pilot Projects; Uterine Diseases

We report a case of vesicouterine fistula presenting after cesarean operation. The fistula was treated successfully by cystoscopic fulguration of the tract and hormonal amenorrhea. Although various surgical approaches to this problem have been described, to date there is no reports of treatment of this problem via cystoscopic fulguration and hormonal amenorrhea. The problem has been solved by hormonal amenorrhea and cystoscopic fulguration. We advocate this simple technique as a primary approach to proper case of vesicouterine fistulas.

Topics: Adult; Amenorrhea; Cystoscopy; Female; Fistula; Gonadotropin-Releasing Hormone; Goserelin; Humans; Urinary Bladder Fistula; Uterine Diseases

To Study the role of gonadotropin releasing hormone agonists (GnRH-alpha) in the treatment of adenomyosis with infertility.. Adenomyosis was diagnosed under lapososcopy in 4 infertile cases. Meanwhile coexsting endometriosis, pelvic adhesion and adenomyoma were treated by surgery and endocoagulator in 4 and 2 cases respectively. GnRH-alpha (triptorelin or goserelin) therapy was given for six months before laparoscopic surgery in 1 case and after laparoscopic surgery in 3 cases. Their fecundity outcome were followed-up after cessation of GnRH-alpha treatment.. All cases became amenorrheic during GnRH-alpha therapy. The enlarged uteri all decreased to normal or near normal size. Menstruation returned in 80-90 days after cessation of treatment. Three cases conceived within four menstrual periods. One of them resulted in the birth of a healthy 3 150 g male at 38 weeks gestation by cesarean section. The second pregnancy resulting after adenomyomectomy was terminated by emergent cesarean section at 30 weeks gestation because of threatened rupture of uterus. The third is now normal at 28 weeks pregnancy. The fourth has had 2 menstrual periods and is still being followed up.. (1) GnRH-alpha thus used is efficient in reducing the adenomyotic uterine size, and may facilitate fertility. (2) For ademyomata associated with infertility, GnRH-alpha therapy may avoid the risk of rupture of uterus which may occur after adenomyomectomy pregnancy. (3) For infertility, GnRH-alpha treatment before laparoscopic surgery greatly decreases surgical difficulties and blood loss in certain cases.

Topics: Adult; Endometriosis; Female; Gonadotropin-Releasing Hormone; Goserelin; Humans; Infertility, Female; Triptorelin Pamoate; Uterine Diseases

Clinical and pathological changes of the mammary gland have been studied in 64 women affected by symptomatic Benign Breast Disease (BBD) coexisting with endometriosis or uterine leiomyomata. These patients were rendered hypoestrogenic by subcutaneous administration of the LH-RH analogue Goserelin depot [D-ser (tBu)6 Aza-Gly10-GnRH (ICI118630)] performed every 28 days, for six months. They were evaluated clinically and ultrasonographically before and after treatment to find possible changes of BBD as well as of endometriosis or uterine leiomyomata. Mammary biopsies were performed before and after treatment in all the patients to study the changes of EGF-R expression. Results showed that clinical improvement is accompanied with a reduction of EGF-R expression.

Topics: Antineoplastic Agents, Hormonal; Endometriosis; ErbB Receptors; Female; Goserelin; Humans; Leiomyomatosis; Uterine Diseases; Uterine Neoplasms

Endometriosis is one of the main causes of female sterility, leading not only to subjective complaints, such as anovulatory menstrual cycles and LUF syndrome, but also to appearance of antisperm antibodies due to the increased number of macrophages, We present our experience in the treatment of endometriosis with the GnRH analogue Zoladex, product of Zeneca, as well as in the treatment of antisperm antibodies with methyiprednizolon acetate, Depomedrol of Upjohn.

Topics: Adult; Delayed-Action Preparations; Drug Therapy, Combination; Endometriosis; Female; Goserelin; Humans; Immunosuppressive Agents; Infertility, Female; Methylprednisolone; Methylprednisolone Acetate; Tablets; Uterine Diseases

Topics: Adnexal Diseases; Adolescent; Adult; Endometriosis; Female; Genital Diseases, Female; Gonadotropin-Releasing Hormone; Goserelin; Humans; Uterine Diseases

Topics: Drug Implants; Endometriosis; Female; Goserelin; Humans; Injections, Subcutaneous; Male; Prostatic Neoplasms; Uterine Diseases

Six premenopausal women with uterine fibroids were treated with a combination of tamoxifen, 20 mg/d, and goserelin, 3.6 mg every 28 days, for a total of 24 weeks. Results were compared with those from six women, matched for pretreatment uterine volume, who had been treated with goserelin alone. During combined therapy, plasma and urinary estrogen concentrations were significantly lower than during goserelin alone, whereas sex hormone binding globulin concentrations were significantly higher. Plasma luteinizing hormone and follicle stimulating hormone (FSH) concentrations were both suppressed, in contrast with results during goserelin alone when FSH levels remained within the pretreatment range. None of the women on combined therapy bled in response to the endocrine changes of the initial treatment cycle. Despite this profound pituitary-ovarian suppression, there was no significant change in uterine volume during combined therapy. These results suggest that tamoxifen is acting as an estrogen agonist in women rendered hypoestrogenic with luteinizing hormone-releasing hormone agonists.

Topics: Amenorrhea; Buserelin; Creatinine; Drug Therapy, Combination; Estradiol; Estrogens; Female; Fibrosis; Follicle Stimulating Hormone; Goserelin; Humans; Luteinizing Hormone; Progesterone; Tamoxifen; Uterine Diseases