leuprolide and Menorrhagia

To discuss a new alternative to treat patients with dysfunctional uterine bleeding who fail to respond to hormonal treatments, and to outline the role of GnRH analogs in the presurgical preparation of these patients.. The causes and various hormonal treatments of dysfunctional uterine bleeding are outlined, and various methods of endometrial ablation, with hormonal and non-hormonal preparations, are reviewed,. In endometrial ablation, while hormonal preoperative treatments are more advantageous than no endometrial suppression, GnRH analogs prepare the endometrium better by reducing thickness uniformly, decreasing edema, and avoiding pseudo-decidual reaction usually present with other hormonal treatments.. Because success of endometrial ablation seems to correlate with uniform destruction of endometrium and superficial portion of myometrium, thinning of the endometrium hormonally simplifies the procedure, adds in the overall success of endometrial ablation, and reduces additional blood loss by controlling the bleeding preoperatively.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Catheter Ablation; Endometrium; Female; Humans; Hysterectomy; Laser Therapy; Leuprolide; Medroxyprogesterone Acetate; Menorrhagia; Menstruation; Premedication; Uterine Hemorrhage

To evaluate the efficacy and safety of ulipristal acetate (UPA) for uterine fibroids (UFs), a phase III study was conducted with leuprorelin (LEU) as a comparator. This is the first confirmatory trial of UPA for UFs among Asians.. Multicenter, randomized, double-blind, double-dummy, parallel-group study.. Thirty-two sites in Japan.. Patients were assigned to 2 arms, with 82 patients in the UPA group and 79 patients in the LEU group.. In the UPA group, 10 mg of UPA was orally administered once a day for 12 weeks. In the LEU group, 1.88 mg or 3.75 mg of LEU was subcutaneously administered at weeks 0, 4, and 8.. The primary endpoint was the percentage of patients with amenorrhea for 35 days. For safety evaluation, adverse events (AEs) were recorded.. The percentage of patients with amenorrhea for 35 days was 87.0% in the UPA group and 81.8% in the LEU group, and the efficacy of UPA for causing amenorrhea for 35 days was confirmed to be noninferior to that of LEU. AEs occurred in 78.0% of the patients in the UPA group and 88.8% of the patients in the LEU group.. The effect of UPA on heavy menstrual bleeding was shown to be comparable with that of LEU in Japanese patients with symptomatic UFs. No notable AEs occurred because of the UPA treatment, and the incidence of AEs in the UPA group was comparable with that of AEs in the LEU group. This result demonstrates the clinical utility of UPA for Asians.

Topics: Adult; Amenorrhea; Double-Blind Method; Female; Humans; Japan; Leiomyoma; Leuprolide; Menorrhagia; Middle Aged; Norpregnadienes; Time Factors; Treatment Outcome; Uterine Neoplasms

To investigate the noninferiority of relugolix compared with leuprorelin acetate in reducing heavy menstrual bleeding associated with uterine leiomyomas.. In a double-blind, double-dummy trial, premenopausal women with uterine leiomyomas and heavy menstrual bleeding defined as a pictorial blood loss assessment chart score of at least 120 were randomized in a 1:1 ratio to relugolix (40 mg, oral, once daily) or leuprorelin acetate (1.88 mg or 3.75 mg, monthly injection) for 24 weeks. The primary endpoint was the proportion of patients with a total pictorial blood loss assessment chart score of less than 10 for weeks 6-12. Secondary endpoints included myoma and uterine volumes, and hemoglobin levels. A sample size of 144 patients per group (n=288) was estimated to provide at least 90% power to demonstrate noninferiority (prespecified noninferiority margin -15%; one-sided 0.025 level of significance).. From March 2016 to September 2017, 281 patients were randomized (relugolix, n=139, leuprorelin n=142). Demographic and baseline characteristics were well balanced; mean pictorial blood loss assessment chart score was 254.3 in the relugolix group and 263.7 in the leuprorelin group. The proportion of patients with total pictorial blood loss assessment chart score of less than 10 for weeks 6-12 was 82.2% in the relugolix group and 83.1% in the leuprorelin group, demonstrating noninferiority of relugolix compared with leuprorelin (relugolix-leuprorelin difference -0.9%; 95% CI: -10.10 to 8.35; prespecified noninferiority margin -15%; P=.001). Reductions in myoma and uterine volumes and increases in hemoglobin levels were comparable in the two groups. Relugolix was associated with an earlier effect on menstrual bleeding than leuprorelin (pictorial blood loss assessment chart score of less than 10, 64.2% vs 31.7% [relugolix-leuprorelin difference 32.5%; 95% CI: 20.95-44.13%] for weeks 2-6 and pictorial blood loss assessment chart score of 0, 52.6% vs 21.8% [30.7%; 95% CI: 19.45-42.00%] for weeks 2-6) and faster recovery of menses after treatment discontinuation (relugolix median [Q1, Q3], 37 days [32.0, 46.0]; leuprorelin median, 65 days [54.0, 77.0]). Adverse events and bone mineral density loss were similar between relugolix and leuprorelin treatment groups.. In women with uterine leiomyomas, once-daily treatment with relugolix, an oral gonadotropin-releasing hormone antagonist, demonstrated noninferiority to monthly leuprorelin for improvement of heavy menstrual bleeding at 6-12 weeks of treatment, had a more rapid effect on menstrual bleeding, and was generally well tolerated.. ClinicalTrials.gov, NCT02655237; JAPIC Clinical Trial Information, JapicCTI-163128.. Takeda Pharmaceutical Company Limited and an affiliate of NovaQuest Capital Management LLC.

Topics: Administration, Oral; Adult; Antineoplastic Agents, Hormonal; Double-Blind Method; Female; Gonadotropin-Releasing Hormone; Hemoglobins; Humans; Injections; Leiomyoma; Leuprolide; Menorrhagia; Middle Aged; Organ Size; Phenylurea Compounds; Pyrimidinones; Severity of Illness Index; Tumor Burden; Uterine Neoplasms; Uterus

To assess the factors associated with future pregnancy and successful delivery in women who were treated for uterine adenomyoma with combination (surgical-medical) therapy using ultramini- or mini-laparotomy conservative surgery and gonadotropin-releasing hormone agonist.. One hundred and two women were evaluated. Items for analysis included: age, body mass index, and conception history; clinical symptoms of dysmenorrhea and menorrhagia; tumor location and preoperative serum level of cancer antigen 125 (CA125); the intraoperative findings of the weight of the removed tumor, and the uterine cavity opening.. After excluding those patients using contraception or searching for an assisted reproductive technique, a total of 56 women were enrolled for analysis. Twenty-three (41.1%) women had 27 clinical pregnancies after 3 years of follow-up; 15 went on to deliver a healthy live-born child; two delivered preterm but healthy babies; seven had elective abortions; four had spontaneous abortions; and one had an ectopic pregnancy. The women who had a successful delivery during the 3-year follow-up after treatment tended to be younger, with a lower body mass index, lower baseline analgesic usage score, and lower preoperative serum level of CA125, be nulliparous, and with an adenoma in an anterior location. The linear regression model showed that age and baseline analgesic usage score were independent predictors of successful delivery and accounted for 56.5% of the total variance related to successful delivery.. Age was an important factor associated with future successful delivery, therefore, caution should be taken in considering the maintenance of future fertility in older women treated with surgical-medical therapy.

Topics: Adenomyoma; Adult; Antineoplastic Agents, Hormonal; Combined Modality Therapy; Dysmenorrhea; Female; Follow-Up Studies; Humans; Infertility, Female; Laparotomy; Leuprolide; Linear Models; Menorrhagia; Middle Aged; Postoperative Complications; Pregnancy; Severity of Illness Index; Treatment Outcome; Uterine Neoplasms; Uterus

The efficacy and side-effect profile of ulipristal acetate as compared with those of leuprolide acetate for the treatment of symptomatic uterine fibroids before surgery are unclear.. In this double-blind noninferiority trial, we randomly assigned 307 patients with symptomatic fibroids and excessive uterine bleeding to receive 3 months of daily therapy with oral ulipristal acetate (at a dose of either 5 mg or 10 mg) or once-monthly intramuscular injections of leuprolide acetate (at a dose of 3.75 mg). The primary outcome was the proportion of patients with controlled bleeding at week 13, with a prespecified noninferiority margin of -20%.. Uterine bleeding was controlled in 90% of patients receiving 5 mg of ulipristal acetate, in 98% of those receiving 10 mg of ulipristal acetate, and in 89% of those receiving leuprolide acetate, for differences (as compared with leuprolide acetate) of 1.2 percentage points (95% confidence interval [CI], -9.3 to 11.8) for 5 mg of ulipristal acetate and 8.8 percentage points (95% CI, 0.4 to 18.3) for 10 mg of ulipristal acetate. Median times to amenorrhea were 7 days for patients receiving 5 mg of ulipristal acetate, 5 days for those receiving 10 mg of ulipristal acetate, and 21 days for those receiving leuprolide acetate. Moderate-to-severe hot flashes were reported for 11% of patients receiving 5 mg of ulipristal acetate, for 10% of those receiving 10 mg of ulipristal acetate, and for 40% of those receiving leuprolide acetate (P<0.001 for each dose of ulipristal acetate vs. leuprolide acetate).. Both the 5-mg and 10-mg daily doses of ulipristal acetate were noninferior to once-monthly leuprolide acetate in controlling uterine bleeding and were significantly less likely to cause hot flashes. (Funded by PregLem; ClinicalTrials.gov number, NCT00740831.).

Topics: Administration, Oral; Adult; Double-Blind Method; Endometrium; Female; Humans; Injections, Intramuscular; Intention to Treat Analysis; Leiomyoma; Leuprolide; Menorrhagia; Middle Aged; Norpregnadienes; Uterine Neoplasms; Young Adult

To compare the effectiveness of leuprorelin and cetrorelix, when used as preoperative endometrial thinning agents prior to transcervical resection of endometrium (TCRE).. A prospective, double-blind randomised controlled trial.. Gynaecological department of a UK district general hospital.. A total of 106 premenopausal women with dysfunctional uterine bleeding, undergoing TCRE.. Women were equally randomised to 3.75 mg of leuprorelin acetate (3-4 weeks) or 3 mg cetrorelix (4-7 days) prior to TCRE. About 1 ml saline was given as placebo in both arms.. Amenorrhoea rate at 6 months, endometrial thickness using transvaginal ultrasound on the day of operation.. A total of 100 women completed the trial with no loss to follow up. Amenorrhoea rate at 6 months after surgery was high in both groups (80% cetrorelix and 84% leuprorelin) with no statistical significance. All endometrial outcome measures including endometrial thickness on ultrasound, histology and operative appearance were more favourable in leuprorelin group as compared with cetrorelix (P values 0.013, <0.001 and 0.003 respectively). More women in leuprorelin group had hot flushes as compared with cetrorelix (15/50 versus 6/50; P = 0.047). No significant differences were seen in other outcome measures.. In dosages used, leuprorelin produced more consistent thinning of the endometrium as compared with cetrorelix, although this did not make any significant difference to operative or menstrual outcomes. The endometrial thinning effect with cetrorelix does appear to be more favourable than that seen at postmenstrual phase in other studies. The optimum (possibly higher) dosage of cetrorelix for this purpose has not yet been established.

Topics: Adult; Double-Blind Method; Endometrium; Female; Gonadotropin-Releasing Hormone; Hormone Antagonists; Humans; Leiomyoma; Leuprolide; Menorrhagia; Menstruation; Patient Satisfaction; Postmenopause; Preoperative Care; Prospective Studies; Treatment Outcome; Uterine Neoplasms

Raloxifene hydrochloride is a synthetic non-steroidal drug used for the prevention and treatment of post-menopausal osteoporosis. Pre-clinical and clinical data have shown that raloxifene may have a beneficial effect on leiomyomas. The aim of this prospective single-blind, randomized, placebo-controlled clinical trial was to evaluate the effectiveness of the addition of raloxifene to GnRH analogues on uterine, leiomyoma, and non-leiomyoma sizes, and on the occurrence of leiomyoma-related symptoms.. After randomization using a computer-generated list, 100 pre-menopausal women with symptomatic uterine leiomyomas received either leuprolide acetate depot plus raloxifene 60 mg daily (group A) or leuprolide plus placebo tablet (group B) for six cycles of 28 days. At baseline and after treatment, uterine, leiomyoma and non-leiomyoma sizes, and leiomyoma-related symptoms were evaluated for each woman. Analysis was by intention-to-treat method.. After six cycles of treatment, a significant decrease in uterine, leiomyoma, and non-leiomyoma sizes was detected in both groups in comparison with baseline. At the same time, no significant difference in uterine and non-leiomyoma sizes was observed between the groups. Leiomyoma sizes were significantly (P < 0.05) lower in group A than in group B. No difference was observed in leiomyoma-related symptoms between groups throughout the study period.. In women treated with GnRH analogue, the raloxifene administration induces a higher reduction of leiomyoma sizes.

Topics: Delayed-Action Preparations; Female; Hot Flashes; Humans; Leiomyoma; Leuprolide; Menorrhagia; Pain; Patient Dropouts; Placebos; Premenopause; Prospective Studies; Raloxifene Hydrochloride; Selective Estrogen Receptor Modulators; Ultrasonography; Uterine Neoplasms

To evaluate the use of pre-operative leuprorelin acetate for reducing the morbidity from hysterectomy for nonfibroid menorrhagia.. A double-blind, randomised, placebo-controlled trial.. Gynaecology department in a large university teaching hospital.. Fifty-one women without uterine fibroids awaiting abdominal or vaginal hysterectomy for dysfunctional uterine bleeding.. Participants received leuprorelin acetate or placebo for eight weeks prior to hysterectomy.. Operative blood loss, operative difficulty, first day morphine use, speed of return to 'normal health'.. The study and control groups were similar as regards prognostic factors. Two women in the study group withdrew because of side-effects. Although a 34% reduction in uterine volume was seen in those treated with leuprorelin, there were no significant differences in operative blood loss (183 mL in the study group vs 285 mL in controls, P = 0.27), operation time (39 vs 49 min, P = 0.64) or operative difficulty (visual analogue scale 3.0 vs 4.0, P = 0.09). Furthermore, there was no difference between the groups in post-operative morbidity or rate of recovery.. Treating women with leuprorelin acetate for 8 weeks prior to surgery for nonfibroid menorrhagia has no significant operative or post-operative benefits.

Topics: Adult; Analgesics, Opioid; Blood Loss, Surgical; Double-Blind Method; Female; Fertility Agents, Female; Humans; Hysterectomy; Leiomyoma; Leuprolide; Menorrhagia; Morphine; Pain, Postoperative; Preoperative Care

Topics: Acute Disease; Adolescent; Adult; Antineoplastic Agents, Hormonal; Female; Humans; Leukemia; Leuprolide; Menorrhagia

Several reports describe enhancing the efficacy of laser or resectoscopic endometrial ablation procedures by preparing the endometrium with danazol or progestin therapy. Because gonadotropin releasing hormone agonists have been found to inhibit the thickness and development of the endometrial lining, preparation of the endometrium for resectoscopic ablation was attempted on eight women using a single injection of 7.5 mg of leuprolide acetate depot. When the ablation was performed, one month after the injection of the medication, which had occurred on day 20-24 of the prior menstrual cycle, the endometrium was thinned in all the patients, with inactive glands, reduced vascularity and atrophic stroma.

Topics: Combined Modality Therapy; Delayed-Action Preparations; Endometrium; Female; Humans; Injections, Intramuscular; Laser Therapy; Leuprolide; Menorrhagia

The aim of this guideline is to provide clinicians with an update to the 2015 Clinical Practice Guideline on the Management of Uterine Fibroids. As new information and evidence has become available since 2015, the Gynaecology Clinical Practice Committee of the Society for Obstetricians and Gynaecologists of Canada has determined that an addendum to that document was necessary to inform members about treatment modalities for uterine fibroids.. Implementation of this guideline update should optimize the decision-making process of women and their health care providers in proceeding with further investigation or therapy for uterine leiomyomas, having considered the disease process and available treatment options and reviewed the risks and anticipated benefits.. Published literature was retrieved through searches of PubMed, CINAHL, and Cochrane Systematic Reviews in February 2015 to April 2018, using appropriate controlled vocabulary (uterine fibroids, myoma, leiomyoma, myomectomy, myolysis, heavy menstrual bleeding, and menorrhagia) and key words (myoma, leiomyoma, fibroid, myomectomy, uterine artery embolization, hysterectomy, heavy menstrual bleeding, menorrhagia). The reference lists of articles identified were also searched for other relevant publications. Results were restricted to systematic reviews, randomized controlled trials or controlled clinical trials, and observational studies. There were no date limits, but results were limited to English or French language materials. Searches were updated on a regular basis and incorporated in the guideline to April 2018. Most of the unpublished data have not been evaluated scientifically. The product monograph was also reviewed up to December 31st, 2018.. The majority of fibroids are asymptomatic and require no intervention or further investigations. For symptomatic fibroids such as those causing menstrual abnormalities (e.g., heavy, irregular, and prolonged uterine bleeding), iron deficiency anemia, or bulk symptoms (e.g., pelvic pressure/pain, obstructive symptoms), hysterectomy is a definitive solution. However, it is not the preferred solution for women who wish to preserve fertility and/or their uterus. The selected treatment should be directed towards an improvement in symptomatology and quality of life. The cost of the therapy to the health care system and to women with fibroids must be interpreted in the context of the cost of untreated disease conditions and the cost of ongoing or repeat investigative or treatment modalities.. The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care.

Topics: Anemia; Antineoplastic Agents, Hormonal; Contraceptive Agents, Hormonal; Female; Gonadotropin-Releasing Hormone; Hematinics; Humans; Iron Compounds; Leiomyoma; Leuprolide; Liver Function Tests; Menorrhagia; Norpregnadienes; Uterine Neoplasms

Hematopoietic stem cell transplant is an effective treatment strategy for a variety of hematologic disorders, but patients are at risk for dysfunctional coagulation and abnormal bleeding. Gynecologists are often consulted before transplant for management of abnormal uterine bleeding, which may be particularly challenging in this context.. A premenopausal woman with MonoMAC (a rare adult-onset immunodeficiency syndrome characterized by monocytopenia and Mycobacterium avium complex infections resulting from mutations in GATA2, a crucial gene in early hematopoiesis) presented with pancytopenia, evolving leukemia, and recent strokes, necessitating anticoagulation. During preparation for hematopoietic stem cell transplant, she experienced prolonged menorrhagia requiring transfusions. Surgical therapy was contraindicated, and medical management was successful only when combined with balloon tamponade.. Balloon tamponade may be a potentially life-saving adjunct to medical therapy for control of uterine hemorrhage before hematopoietic stem cell transplant.

Topics: Adult; Antineoplastic Agents, Hormonal; Contraceptives, Oral, Synthetic; Estrogens; Female; GATA2 Transcription Factor; Hematopoietic Stem Cell Transplantation; Humans; Immunologic Deficiency Syndromes; Induction Chemotherapy; Leiomyoma; Leuprolide; Medroxyprogesterone; Menorrhagia; Stroke; Uterine Balloon Tamponade; Uterine Neoplasms

Topics: Female; Humans; Leiomyoma; Leuprolide; Menorrhagia; Norpregnadienes; Receptors, Progesterone; Uterine Neoplasms

Topics: Adult; Anemia, Iron-Deficiency; Antineoplastic Agents, Hormonal; Female; Hemoglobins; Humans; Iron; Kidney Failure, Chronic; Leiomyoma; Leuprolide; Menorrhagia

Topics: Abdominal Pain; Danazol; Diagnosis, Differential; Dysmenorrhea; Endometriosis; Estrogen Antagonists; Female; Gonadotropin-Releasing Hormone; Goserelin; Humans; Hysterectomy; Laparoscopy; Leuprolide; Menorrhagia; Nafarelin; Nursing Assessment; Physical Examination; Progesterone; Severity of Illness Index

Topics: Adult; Clinical Trials as Topic; Estrogen Replacement Therapy; Female; Fertility Agents, Female; Gonadotropin-Releasing Hormone; Hormones; Humans; Leuprolide; Menorrhagia; Stem Cell Transplantation

The aim of this study was to determine which factors in the perioperative period influence the success of endometrial ablation in alleviating menorrhagia.. We performed a retrospective chart review of 120 women aged 27 to 49 years who underwent endometrial ablation after 2 months of preoperative treatment with danazol (Danocrine, 800 mg/d orally) or leuprolide (Lupron, 3.75 mg in one intramuscular injection each month). Patients who required medical management or additional operations to control the vaginal bleeding during follow-up (median follow-up, 37 weeks) were considered to have ablation failures.. Sixty-three percent of patients (76/120) had a successful procedure. The chance of success was greater if a cavity of normal appearance was found (odds ratio, 2.3; P =.04). The finding of an intramural fibroid before the procedure resulted in a reduced trend toward success (odds ratio, 0.4; P =.06). The use of danazol pretreatment improved the rate of success overall (odds ratio, 2.2; P =.05) and especially among women <40 years old (P =.01). Perioperative findings may provide useful information in counseling patients regarding endometrial ablation. Success is greater among patients with a normal intrauterine cavity and after preoperative treatment with danazol.

Topics: Adult; Danazol; Endometrium; Estrogen Antagonists; Female; Humans; Leiomyoma; Leuprolide; Logistic Models; Menorrhagia; Middle Aged; Premedication; Reoperation; Retrospective Studies; Treatment Failure; Treatment Outcome; Uterine Neoplasms

In order to assess the efficacy and tolerability of leuprorelin acetate depot in pre-operative flattening of the endometrium prior to hysteroscopic endometrial ablation, 94 patients from eight centres were included in the per protocol analysis.. The patients included were pre- or peri-menopausal, had completed their family planning and had intractable uterine bleeding. The primary target criterion was the reduction in maximum endometrial thickness after two injections of leuprorelin acetate depot with an interval of four weeks between injections. Surgery took place two weeks after the second injection.. Sufficient pre-treatment was achieved in 91.5% of the patients with > 50% decrease and/or a type 1 endometrium according to sonographic and/or endometrial atrophy (Score 11) according to the central histological evaluation. The endometrium was flattened by a mean of 4.0 +/- 4.1 mm. In terms of clinical response, amenorrhoea, hypomenorrhoea or normal menstruation were achieved after endometrial ablation. Hence 91.5% of patients benefited from the overall treatment after six weeks and still 83% after six months. The trial medication was well tolerated overall. The most common side-effect described was hot flushes which could be attributed to the deliberate oestrogen withdrawal.. In view of the good study results, hormone-suppressive pretreatment of the endometrium can be recommended prior to elective ablation. Surgery should take place during the oestrogen-suppressed phase.

Topics: Adult; Biopsy; Delayed-Action Preparations; Drug Administration Schedule; Endometrial Hyperplasia; Endometrium; Female; Humans; Hysteroscopy; Leuprolide; Menorrhagia; Metrorrhagia; Middle Aged; Preoperative Care

To determine 5-year results of endometrial ablation with the SideFire laser fiber.. All women seen in private office who were candidates for this procedure were followed over 5 years (Canadian Task Force classification II-2).. Patients were pretreated with depot leuprolide acetate in a private office. All procedures were done in an outpatient surgery center, and no patient was admitted to the hospital.. Eighty-six women with increased bleeding.. Endometrial ablation with the SideFire laser fiber.. After follow-up of 12 to 72 months, 100% of patients had excellent results; 70 (82%) had total amenorrhea. Results were not less satisfactory in younger women.. The SideFire laser fiber seems to be a good alternative that achieves improved outcomes compared with electrosurgery and balloon devices with hot fluid or electrodes. (J Am Assoc Gynecol Laparosc 6(1):65-69, 1999)

Topics: Adult; Endometrium; Female; Follow-Up Studies; Humans; Laser Therapy; Leuprolide; Menorrhagia; Middle Aged

Since October 1996, at our fibroid center, we have been using the uterine artery embolization (UAE) procedure as a nonsurgical means to treat patients with fibroids and menorrhagia. We have performed this procedure on over 180 patients, 3 of whom experienced vaginal expulsion of submucosal fibroids from two to seven months later.. A 37-year-old woman underwent UAE in November 1997 and expelled five submucosal fibroids two to three months later. A 43-year-old woman underwent UAE in August 1997 and expelled a submucosal fibroid four months later. A 46-year-old woman underwent UAE in April 1997 and expelled a submucosal fibroid seven months later.. The use of UAE to treat patients with fibroids and menorrhagia is relatively new. Our experience has revealed that a significant percentage of patients who have had the embolization procedure will have reduction in menorrhagia and also in the volume of their fibroids. Complications and side effects have been few. Vaginal expulsion of submucosal fibroids can be viewed as a side effect of the procedure, and, to the best of our knowledge, these are the first reported cases of this postembolization occurrence.

Topics: Adult; Antineoplastic Agents, Hormonal; Combined Modality Therapy; Embolization, Therapeutic; Female; Humans; Leiomyoma; Leuprolide; Menorrhagia; Middle Aged; Treatment Outcome; Uterine Neoplasms

To assess the relationship of menstrual timing of administration of gonadotropin-releasing hormone (GnRH) agonist on the effectiveness of endometrial thinning and unwanted uterine bleeding.. Prospective observational study.. Gynecology department of a community hospital.. One hundred consecutive women in a private practice, without submucous myomas, scheduled for transcervical endomyometrial resection or ablation.. A GnRH agonist was administered at an unspecified time of the menstrual cycle. Transcervical hysteroscopic endomyometrial resection or ablation was performed 1 month later.. No significant statistical differences were seen in either the effectiveness of endometrial thinning or the occurrence or severity of unwanted uterine bleeding.. A GnRH agonist as pretreatment for endomyometrial resection or ablation can be administered at any time during the menstrual cycle with similar efficacy. Timing of surgery can be at the mutual convenience of patient and physician.

Topics: Adult; Antineoplastic Agents, Hormonal; Drug Administration Schedule; Endometrium; Female; Follow-Up Studies; Gonadotropin-Releasing Hormone; Humans; Hysterectomy; Leuprolide; Menorrhagia; Menstruation; Middle Aged; Observation; Postoperative Complications; Preoperative Care; Prospective Studies; Time Factors

Gonadotropin-releasing hormone agonists (GnRH-a) are effective in reducing the pituitary release of gonadotropins, which, in turn, decrease ovarian steroidogenesis. The resulting menopausal state decreases the volume and vascular supply to uterine leiomyomas. Peripheral adipose tissue also contributes significantly to the circulatory estrogen pool, which is formed independent of pituitary function. As such, obesity may interfere with depot leuprolide acetate effects, allowing normal estrogen levels despite gonadotropin suppression.. A premenopausal, morbidly obese woman was referred for treatment of menorrhagia and uterine leiomyomas. Despite administration of depot leuprolide, a GnRH-a, she continued to bleed heavily. Serum estradiol levels remained in the normal range, with suppression of follicle-stimulating hormone (FSH) levels. The desired hypoestrogenic effect from GnRH-a administration was thought to be negated by estradiol levels arising from peripherally derived conversion of adrenal androgens in adipose tissue. A GnRH stimulation test was performed to evaluate the responsiveness of the pituitary to the above therapy. While FSH was suppressed and unresponsive to stimulation, estradiol remained unchanged.. Peripheral production of estrogen appears to be unaffected by leuprolide administration. Consideration should be given to the patient's body habitus when administering a GnRH suppressant. Morbidly obese patients possess an unlimited reservoir for peripheral estrogen synthesis.

Topics: Adipose Tissue; Antineoplastic Agents, Hormonal; Estrogens; Female; Gonadotropin-Releasing Hormone; Humans; Leiomyoma; Leuprolide; Menorrhagia; Middle Aged; Obesity, Morbid; Uterine Neoplasms

To evaluate the prevalence of resumption of menstruation after an interval of amenorrhea in women treated by endometrial ablation and myometrial resection.. Retrospective analysis.. Tertiary care university-affiliated teaching hospital.. One hundred fifty-seven consecutive patients treated for menorrhagia refractory to medical therapy.. Loop resection or rollerball ablation of the endometrium.. At 6 to 12 months postoperatively, 50. 6% of patients were amenorrheic and 35.1% had hypomenorrhea. Over follow-up of 13 to 30 months, 45.1% of women became amenorheic and 40.5% had satisfactory hypomenorrhea. Resumption of menstruation after any interval of amenorrhea occurred in 27.2% of amenorheic patients. We observed an increasing trend to resumption of menstruation after rollerball ablation (29.4%) compared with loop resection (26.7%) and after preoperative endometrial suppression with buserelin (37.5%) and leuprolide (27.1%) compared with danazol (12.5%) and goserelin (10.5%). Resumption of menstruation occurred in 44.4% of women who did not have preoperative endometrial suppression.. Our results suggest that resumption of menstruation does occur after a variable interval of amenorrhea following endometrial ablation and myometrial resection. It could potentially be used as a marker of failure of endometrial destruction.

Topics: Amenorrhea; Buserelin; Danazol; Electrocoagulation; Endometrium; Female; Follow-Up Studies; Goserelin; Humans; Leuprolide; Menorrhagia; Myometrium; Postoperative Complications; Preoperative Care; Retrospective Studies; Time Factors; Treatment Failure

To evaluate the effectiveness of transcervical resection of the endometrium and indications for late reoperation.. Retrospective study.. Central hospital in northern Norway.. Two hundred fifty women (age 30-59 yrs) with dysfunctional bleeding.. Hysteroscopic transcervical resection of the endometrium.. Success as measured by patient satisfaction at 3-month follow-up was 97% and at 4 to 48 months was 91.6%. Mean observation time was 24 months. Twenty-one women required further surgery. Repeat resection was performed in eight women (3.2%), of whom 95% were satisfied. Thirteen women (5.2%) had a hysterectomy. Late reoperation was performed in 7 patients (2.8%) due to recurrent unacceptable vaginal bleeding and in 14 (5.6%) due to late onset of pain.. After endometrial resection, a definite subgroup (8.4%) of women developed late onset of pain or bleeding requiring reoperation.

Topics: Adult; Electrocoagulation; Endometrium; Female; Follow-Up Studies; Humans; Leuprolide; Menorrhagia; Middle Aged; Patient Satisfaction; Preoperative Care; Reoperation; Retrospective Studies; Time Factors; Treatment Outcome

To study a standardized technique for endometrial rollerball ablation and various methods of preoperative preparation.. All patients had refractory symptomatic menorrhagia and previously failed conservative surgery and other forms of medical therapy, such as progestogens. Patients received a preoperative regimen of either leuprolide acetate, danazol, Nolvadex or Depo-Provera. They then underwent hysteroscopically controlled rollerball ablation at 80-100 W with 1.5% glycine as the distending medium. The endometrium was evaluated hysteroscopically and considered to be completely atrophic, intermediate or no response.. Refractory symptomatic menorrhagia was treated successfully in 38 of 40 patients. Nineteen reported amenorrhea; the other 21 reported subjective and objective improvement of bleeding. Three patients, despite improvements in flow, were unhappy with the overall result. Two did not wish repeat ablation and subsequently underwent vaginal hysterectomy. The third underwent repeat ablation and became amenorrheic. The ability to achieve complete endometrial atrophy prior to ablation was improved with leuprolide acetate (19/24) and danazol (5/6) when compared to tamoxifen (0/4) and Depo-Provera (0/6). Attainment of amenorrhea after ablation was significantly improved when complete atrophy (19/24) was achieved prior to ablation as compared to the ability to achieve amenorrhea when no endometrial response was achieved (0/7). The only significant complication was one uterine perforation in a patient undergoing repeat ablation.. Endometrial rollerball ablation is a safe, effective means of controlling refractory menorrhagia. Amenorrhea is best attained when complete preoperative atrophy is achieved. Leuprolide and danazol were superior to tamoxifen and Depo-Provera.

Topics: Antineoplastic Agents; Atrophy; Danazol; Dilatation and Curettage; Electrocoagulation; Endometrium; Estrogen Antagonists; Female; Humans; Hysteroscopy; Leuprolide; Medroxyprogesterone Acetate; Menorrhagia; Preoperative Care; Retrospective Studies; Tamoxifen; Treatment Outcome

To assess the effectiveness of treating adenomyomata with laparoscopic bipolar coagulation.. Prospective, observational study. Setting. The gynecology department of a community hospital.. Ten women, each with severe dysmenorrhea, chronic menorrhagia, and adenomyomata diagnosed by magnetic resonance imaging.. Laparoscopic bipolar coagulation of adenomyomata.. The mean (+/- SEM) total adenomyoma volume before leuprolide acetate administration was 119 +/- 16 cm3 (range 6-190 cm3); after 3 months of therapy this was reduced to 86 +/- 8 cm3 (range 6-162 cm3, p <0. 0001) a 27.7% reduction. Further reduction occurred 7 to 12 months postoperatively to 31 +/- 3.4 cm3 (range 3-155 cm3, p <0.0001), a 73.9% reduction from baseline. Twelve months postoperatively, seven (70.0%, p <0.05) women had continued resolution or significant reduction of dysmenorrhea and resolution of menorrhagia. One woman (10.0%) with unresolved dysmenorrhea and menorrhagia required hysterectomy, and two (20.0%) with recurrent menorrhagia required resection of the endomyometrium; one continued to have menorrhagia but refused further surgical or medical treatment.. Conservative treatment obviated the need for major surgery in 90% of women with adenomyomata, but further evaluation of this technique is necessary to determine its definitive role.

Topics: Adenomyoma; Adult; Antineoplastic Agents, Hormonal; Dysmenorrhea; Electrocoagulation; Female; Humans; Laparoscopy; Leuprolide; Magnetic Resonance Imaging; Menorrhagia; Middle Aged; Recurrence; Uterine Neoplasms

In a retrospective study, the value of pretreatment with a gonadotropin-releasing-hormone (GnRH) agonist before hysteroscopic myoma resection was assessed in 31 patients suffering from menorrhagia. No difference in operating time, intra-operative fluid deficit, blood loss and postoperative eumenorrhoea rate was found between pretreated and non-pretreated patients with solitary submucous myomas smaller than 4 cm in diameter. Thus, pretreatment with GnRH agonists before the resection of small solitary submucous myomas has no benefit for the patients.

Topics: Antineoplastic Agents, Hormonal; Endoscopy; Female; Humans; Hysteroscopy; Leiomyoma; Leuprolide; Menorrhagia; Premedication; Retrospective Studies; Uterine Neoplasms; Uterus

Menorrhagia was treated with the "rollerball" method for five years, 1988-1993, in 200 patients. All the patients were evaluated and treated at Kaiser-Permanente facilities in northern California. All patients were candidates for hysterectomy based on excessive bleeding from benign conditions. The procedures were done on an out-patient basis. Complications were minimal, with a mean follow-up of 2.5 years. Relief was achieved in 90% of patients. Eight patients required repeat ablations. Of those, one required hysterectomy. Ten patients had hysterectomies following rollerball ablation. The data add to the growing opinion that endometrial ablation ("rollerball") is an economical, effective method of treating menorrhagia without resorting to hysterectomy.

Topics: Electrocoagulation; Endometrium; Female; Humans; Hysterectomy; Leuprolide; Life Tables; Medroxyprogesterone Acetate; Menorrhagia; Norethindrone; Norethindrone Acetate; Postoperative Complications; Reoperation; Uterine Hemorrhage

This study compared the costs of endometrial ablation using the uterine resectoscope to those of hysterectomy in a group of patients treated for abnormal uterine bleeding who were enrolled in a national managed health care organization. The cost of endometrial ablation during the periprocedural period was significantly lower than that of hysterectomy, with much of the difference coming from the hospitalization required for the latter procedure. The postprocedural cost for ablation was higher than for hysterectomy owing to the need for second ablations or hysterectomy in 13 of the 85 ablation patients. Preprocedure costs were not different between ablation and hysterectomy. A reanalysis of the data, however, that excluded patients who required a second ablation or hysterectomy suggested that these additional procedures were responsible for the higher postprocedural costs in the ablation group. Resectoscopic endometrial ablation for the treatment of abnormal uterine bleeding resulted in lower periprocedure costs and lower overall treatment costs to the health plan in the groups studied as compared with hysterectomy. Greater familiarity with the technique of resectoscopic endometrial ablation, improved patient selection for the procedure and the use of appropriate pharmacotherapy for suppressing endometrial growth prior to ablation probably substantially improve the rate of success, reduce postprocedural costs and further enhance the cost advantage of this procedure.

Topics: Adult; Costs and Cost Analysis; Danazol; Electrocoagulation; Endometrium; Female; Humans; Hysterectomy; Leuprolide; Menorrhagia; Postoperative Care; Preoperative Care; Prospective Studies; Treatment Outcome

Topics: Bone Marrow Transplantation; Female; Humans; Leuprolide; Menorrhagia; Premenopause

We report on the use of leuprolide to prevent heavy menstrual bleeding that often occurs before platelet engraftment in premenopausal women undergoing bone marrow transplantation (BMT). Leuprolide, a synthetic analog of gonadotropin-releasing hormone (Gn-RH-a), was given to 34 patients by intravenous bolus injection, 1 mg daily, until platelet recovery. The median duration of therapy was 50 days (range 16-170). When necessary, patients self-administered the drug after discharge from the hospital. No adverse effects could be related directly to the use of leuprolide. Leuprolide effectively prevented menstruation in 25 patients (73%), failed in seven (21%), and two patients were not evaluable. The success of leuprolide therapy was related to the time of onset of treatment, as anticipated from the gradual effect of Gn-RH-a on the menstrual cycle. The failure rate was only 6% (one of 16 patients) when leuprolide was started at least 2 weeks prior to the development of thrombocytopenia, compared to a failure rate of 33% (six of 18 patients) when leuprolide was started at a later time. We conclude that leuprolide as a single agent is a safe and effective method to prevent menstrual bleeding during BMT. Additional studies are needed to determine the best timing for the onset of therapy and the relative benefit of leuprolide compared to other prophylactic approaches in patients with lengthy thrombocytopenia.

Topics: Adolescent; Adult; Bone Marrow Transplantation; Female; Humans; Leuprolide; Menorrhagia; Menstrual Cycle; Middle Aged; Retrospective Studies

Of 143 women who underwent endometrial ablation between May 1986 and August 1991, 16 also had repeat procedures. Medical preparation of the endometrial lining (danazol, leuprolide acetate, or nafarelin acetate) was used in 109 patients; mechanical preparation in the form of suction curettage, in 28 patients; and no preparation, in 6 postmenopausal patients. Evaluation of the results following endometrial ablation showed that the results in mechanically prepared patients were comparable to those in patients receiving traditional medical preparation; thus mechanical preparation can make the procedure simpler, enhance patient compliance, and reduce side effects considerably.

Topics: Cohort Studies; Danazol; Electrocoagulation; Endometrium; Female; Humans; Leuprolide; Light Coagulation; Menorrhagia; Nafarelin; Premedication; Preoperative Care; Treatment Outcome; Vacuum Curettage

Moderate ovarian hyperstimulation syndrome occurred after LA was administered to control menorrhagia in an anephric woman who required hemodialysis. We postulate that women who require dialysis may be at special risk for the development of this syndrome.

Topics: Adult; Delayed-Action Preparations; Estradiol; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Hormones; Humans; Kidney Failure, Chronic; Leuprolide; Menorrhagia; Ovarian Cysts; Ovary; Renal Dialysis; Syndrome; Triptorelin Pamoate

Three cases of heavy vaginal bleeding during leuprolide acetate therapy for leiomyomata are reported. In all cases, acute anemia developed, necessitating blood transfusions and emergency myomectomies. Pathologic diagnoses demonstrated hyaline degeneration of submucous fibroids in each instance.

Topics: Adult; Antineoplastic Agents; Female; Gonadotropin-Releasing Hormone; Humans; Leiomyoma; Leuprolide; Menorrhagia; Uterine Neoplasms

Topics: Administration, Cutaneous; Administration, Oral; Adult; Estrogens; Female; Fertility; Gonadotropin-Releasing Hormone; Hormones; Humans; Injections, Subcutaneous; Leuprolide; Medroxyprogesterone; Medroxyprogesterone Acetate; Menorrhagia