leuprolide and Uterine-Hemorrhage

The purpose of this study was to provide a systematic review on prevention and treatment of uterine bleeding in the setting of hematologic malignancy. We performed MEDLINE, PubMed, EMBASE and Cochrane searches with the terms uterine bleeding, uterine hemorrhage, hematologic malignancy. All identified literature sources were included in the review. The identified literature is largely comprised of case series and pilot studies. No evidence-based protocols for gynecologists and hematologists are available. The majority of the identified literature centers on menstrual suppression with GnRH agonists in hematologic malignancy, although no randomized trials could be identified. Review of the identified literature suggests that medical prevention with GnRH agonist therapy is highly effective for prevention of uterine bleeding in hematologic malignancy. With respect to treatment of acute uterine bleeding in the setting of hematologic malignancy, medical therapy can be used and is successful in the majority of patients, according to the identified studies. Surgical treatment should be used expeditiously if medical treatment options fail to control acute bleeding. Empiric prevention and treatment algorithms for the discussed clinical settings are proposed. More research is necessary on the topic, with the goal to develop evidence-based guidelines for gynecology and hematology-oncology care providers. Close cooperation between the specialties may improve morbidity and mortality associated with uterine bleeding in hematological malignancy in the future.

Topics: Antineoplastic Agents; Clinical Trials as Topic; Female; Hematologic Neoplasms; Humans; Leuprolide; Menstruation; Premenopause; Receptors, LHRH; Transplantation Conditioning; Uterine Hemorrhage

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 compare the efficacy and safety of SC depot medroxyprogesterone acetate (DMPA-SC 104) with that of leuprolide acetate in treatment of endometriosis.. Phase 3, multicenter, randomized, evaluator-blinded, comparator-controlled trial.. Clinical trial sites in Canada and United States.. Two hundred seventy-four women with surgically diagnosed endometriosis.. Intramuscular injections of DMPA-SC (104 mg) or leuprolide acetate (11.25 mg), given every 3 months for 6 months, with 12 months of posttreatment follow-up.. Reduction in five endometriosis symptoms or signs (dysmenorrhea, dyspareunia, pelvic pain, pelvic tenderness, pelvic induration); change in bone mineral density (BMD), hypoestrogenic symptoms, bleeding, and weight.. The depot medroxyprogesterone acetate given SC was statistically equivalent to leuprolide in reducing four of five endometriosis symptoms or signs at the end of treatment (month 6) and in reducing all five symptoms after 12 months' follow-up (month 18). Patients in the DMPA-SC 104 group showed significantly less BMD loss than did leuprolide patients at month 6, with scores returning to baseline at 12 months' follow-up. No statistically significant differences in median weight changes were observed between groups. Compared with leuprolide, DMPA-SC 104 was associated with fewer hypoestrogenic symptoms but more irregular bleeding.. Efficacy of DMPA-SC 104 was equivalent to that of leuprolide for reducing endometriosis-associated pain, with less impact on BMD and fewer hypoestrogenic side effects but more bleeding.

Topics: Adult; Bone Density; Delayed-Action Preparations; Endometriosis; Estrogens; Female; Flushing; Humans; Injections, Subcutaneous; Leuprolide; Medroxyprogesterone Acetate; Pain; Palliative Care; Quality of Life; Single-Blind Method; Treatment Outcome; Uterine Hemorrhage

To evaluate the effectiveness of trichloroacetic acid (TCA) instillation into uterine cavity for the treatment of dysfunctional uterine bleeding (DUB).. Prospective clinical study.. A university research hospital.. Ninety women participated who had dysfunctional uterine bleeding.. Ninety-five percent of TCA was instilled into uterine cavity for endometrial ablation in women with dysfunctional uterine bleeding who want conservative treatment. Participants in group 1 received only TCA; participants in group 2 received a single dose of gonadotropin-releasing hormone analogue 1 month before the procedure.. All participants underwent an evaluation that included cycle history, body mass index measurement, and transvaginal ultrasonography of pelvis, diagnostic hysteroscopy and endometrial biopsy.. At the end of 12 months of the treatment, amenorrhea rates in group 1 and group 2 were 26.7% vs. 31.1%, with pooled amenorrhea, hypomenorrhea, and eumenorrhea rates of 95.6% vs. 97.8%, respectively. There was no significant difference between the groups vis-a-vis postprocedure results. More than 90% of women who have this procedure are satisfied with the results. There were no observed negative effects or related complications with this treatment.. An instillation of TCA into uterine cavity produces acceptable results and provides conservative management of DUB.

Topics: Adult; Female; Humans; Leuprolide; Middle Aged; Prospective Studies; Trichloroacetic Acid; Uterine Hemorrhage

We performed a randomized controlled study to determine the efficacy of add-backed therapy by every-other-day administration of 0.625 mg conjugated equine estrogen (CEE) and 2.5 mg medroxyprogesterone acetate (MPA) on GnRH agonists (GnRH-a) treatment in Japanese women with symptomatic endometriosis. At the end of treatment, serum estrone and estradiol levels in the add-back group (n = 11) were significantly higher than those in the control group (n = 10). The assessment of Beecham classification by bimanual examination, serum CA-125 levels, and the frequency of genital bleeding revealed no significant differences between the two groups. The add-back group showed reduced Kupperman indices relative to those of the control group, and could prevent the loss of bone density. These findings led to a conclusion that GnRH-a therapy added back by every-other-day administration of 0.625 mg CEE and 2.5 mg MPA was a safe and effective treatment for Japanese women with endometriosis.

Topics: Adult; Animals; Bone Density; Bone Remodeling; CA-125 Antigen; Endometriosis; Estradiol; Estrogens, Conjugated (USP); Estrone; Female; Gonadotropin-Releasing Hormone; Horses; Humans; Leuprolide; Medroxyprogesterone Acetate; Middle Aged; Uterine Hemorrhage

In order to assess the endocrinological changes associated with 2 types of low-dose GnRH agonists depot as well as their clinical efficacy, we performed a randomized prospective comparison study of patients having uterine leiomyomas or endometriosis.. A prospective randomized study involving 67 patients with uterine leiomyomas or endometriosis was carried out. These patients were randomly administered either buserelin MP 1.8 mg (Group B, n = 34) or leuprolide 1.88 mg (Group L, n = 33). In each group we evaluated the symptoms of genital bleeding and hot flashes during GnRHa treatment, as well as the levels of serum LH, FSH, and estradiol 8 weeks after the start of treatment. In addition, the endometrial thickness was measured by transvaginal ultrasonography, and changes in the volume of the uterine leiomyoma or endometrial cyst at the end of treatment. The GnRHa depot was administered from 3 to 8 times, 28 days apart, in both groups.. The incidence of menstruation-like genital bleeding 8 weeks after treatment was significantly (p < 0.01) higher in Group B. However this difference disappeared by 12 weeks after treatment. The climacteric symptom of hot flashes was found to be significantly (p < 0.01) more severe in Group L, and this tendency continued until 20 weeks after treatment. The 2 groups did not differ significantly with regard to the levels of the serum LH, FSH, and estradiol at 8 weeks after treatment or in the endometrial thickness at the end of the GnRHa treatment. In both groups, the volumes of the uterine leiomyomas were significantly (p < 0.01) lower after the treatment. In contrast, the volumes of the endometrial cysts did not decrease after administration of GnRHa in both groups.. Leuprolide 1.88 induced pituitary down regulation more rapidly than buserelin MP. However the hypoestrogenic symptoms such as hot flashes were more severe in cases treated with leuprolide 1.88 than in those treated with buserelin MP. Our data confirm that the therapeutic efficacy of buserelin MP and leuprolide 1.88 are similar, with both being sufficient to treat uterine leiomyomas and endometriosis.

Topics: Adult; Antineoplastic Agents, Hormonal; Buserelin; Endometriosis; Endometrium; Estradiol; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Hot Flashes; Humans; Leiomyoma; Leuprolide; Luteinizing Hormone; Male; Middle Aged; Ovarian Diseases; Prospective Studies; Treatment Outcome; Ultrasonography; Uterine Diseases; Uterine Hemorrhage

Our purpose was to assess the changes in uterine volume and uterine artery pulsatility index in response to gonadotropin-releasing hormone agonist treatment in women undergoing hysterectomy for nonfibroid-related uterine bleeding.. A double-blind, placebo-controlled randomized trial of 51 women awaiting hysterectomy in a gynecology outpatient clinic was conducted. The women were treated for 8 weeks with either leuprolide acetate depot or placebo. Vaginal ultrasonographic examinations were performed before and after treatment. The paired t test was used for statistical analysis.. In those allocated to therapy with gonadotropin-releasing hormone agonist the mean uterine volume decreased by 34% and the uterine artery pulsatility index increased from 2.25 to 2.7. No significant changes were seen in the placebo group. The intersonographer variability was low and there was a high correlation between uterine size as measured by ultrasonography before hysterectomy and that measured postoperatively.. Treatment with gonadotropin-releasing hormone agonists leads to uterine shrinkage and an increase in the uterine artery pulsatility index even in the absence of uterine fibroids.

Topics: Adult; Arteries; Double-Blind Method; Endometriosis; Estradiol; Female; Gonadotropin-Releasing Hormone; Humans; Hysterectomy; Leuprolide; Middle Aged; Postoperative Period; Preoperative Care; Pulse; Ultrasonography; Uterine Hemorrhage; Uterus

Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Female; Hematopoietic Stem Cell Transplantation; Hormone Replacement Therapy; Humans; Leukemia; Leuprolide; Lymphoma; Middle Aged; Premenopause; Risk Factors; Uterine Hemorrhage; Vascular Diseases

To determine the effectiveness of leuprolide acetate depot plus iron compared with iron alone in the preoperative treatment of anemia due to prolonged or excessive bleeding associated with uterine leiomyomas.. This was a phase III, stratified, randomized, double-blind, placebo-controlled, parallel-group, 12-week multicenter study. Enrolled patients had hemoglobin levels of 10.2 g/dL or less and/or hematocrit values of 30% or less. Patients were entered into one of two strata based on their pre-study hematocrit level: stratum A, hematocrit less than or equal to 28%, and stratum B, hematocrit greater than 28%. Patients within each stratum were randomized to one of three treatment arms: leuprolide acetate depot 7.5 mg, leuprolide acetate depot 3.75 mg, or placebo. All patients received iron orally. Response was defined as a hemoglobin level of 12 g/dL or more and a hematocrit value of 36% or greater.. Three hundred nine patients were entered into the study, of whom 265 were evaluated. Using our response criteria, a significantly greater number of patients in both leuprolide acetate groups (combined strata) responded to therapy than did those in the placebo group: 74% in each leuprolide acetate group versus 46% in the placebo group (P < .001). Gonadotropin-releasing hormone agonist-treated patients had a significant reduction in uterine and myoma volume when compared with the placebo group (P < .01). Hot flashes and vaginitis were reported significantly more often (P < .001) in the leuprolide acetate-treated groups than in the placebo group.. Both dosages of GnRH agonist plus iron were more effective than iron alone in treating the anemia of patients with uterine leiomyomas, in reducing uterine-myoma volume, and in alleviating bleeding and other leiomyoma-related symptoms.

Topics: Adult; Anemia, Iron-Deficiency; Bone Density; Delayed-Action Preparations; Double-Blind Method; Drug Therapy, Combination; Female; Hematocrit; Hemoglobins; Humans; Iron; Leiomyoma; Leuprolide; Middle Aged; Preoperative Care; Uterine Hemorrhage; Uterine Neoplasms

To evaluate leuprolide acetate (LA) depot (Enantone Depot, Takeda, Italy) when administered preoperatively in hysteroscopic surgery.. Prospective, comparative study.. University Clinic of Obstetrics and Gynecology.. One hundred ninety-three patients (114 pretreated with LA depot and 79 controls) who underwent hysteroscopic surgery for uterine septa (group A), submucous fibroids (group B), and abnormal uterine bleeding (group C).. In groups B and C there was a significant reduction in the operating time, bleeding during the operation, and the amount of distention medium required after LA depot administration, but no significant differences in surgical feasibility or efficacy were found in group A patients after treatment.. Preoperative treatment with LA depot is effective in making hysteroscopic surgery easier.

Topics: Adult; Delayed-Action Preparations; Endometrium; Female; Humans; Hysteroscopy; Leuprolide; Myometrium; Prospective Studies; Uterine Hemorrhage; Uterine Neoplasms; Uterus

This study investigated the efficacy of GnRH agonists concomitantly with transient aromatase inhibitor and tranexamic acid to treat women with uterine arteriovenous malformations (AVMs) associated with abnormal uterine bleeding (AUB) to preserve fertility and determine reproductive outcome.. This was a prospective cohort study in a tertiary centre. Doppler ultrasound demonstrated AVM in 19 women with AUB 1-28 weeks following spontaneous or therapeutic abortion and in one woman 4 years after normal pregnancy while taking an oral contraceptive. On the basis of experience from the first three cases, 17 women were treated with tranexamic acid (1 g three times daily orally for 5 days), a GnRH agonist (3.75-11.25 mg, for 1-3 months), plus an aromatase inhibitor (letrozole 2.5 mg once daily for 5days) with the initial injection of GnRH agonist. Two women required blood transfusion, and one required uterine tamponade with Foley catheter balloon in the first 48 hours to control heavy bleeding (Canadian Task Force Classification II-2).. All 20 AVMs resolved within 1-3 months of treatment. Of 16 women who attempted pregnancy, all (100%), including two who had uterine artery embolization (one after hysteroscopic septoplasty), conceived spontaneously with 18 live births. Two women are using contraception (one taking an oral contraceptive, one using a levonorgestrel intrauterine system), and one 40-year-old is not using contraception. One woman had hysteroscopic endometrial ablation followed by vaginal hysterectomy for AUB at 1 and 2 years later.. A GnRH agonist in combination with transient aromatase inhibitor and tranexamic acid is an effective management strategy to treat and maintain reproduction in women with AVMs associated with AUB.

Topics: Abortion, Spontaneous; Adult; Antifibrinolytic Agents; Aromatase Inhibitors; Arteriovenous Fistula; Arteriovenous Malformations; Blood Transfusion; Cohort Studies; Female; Fertility; Fertility Agents, Female; Gonadotropin-Releasing Hormone; Goserelin; Humans; Letrozole; Leuprolide; Prospective Studies; Tranexamic Acid; Treatment Outcome; Ultrasonography, Doppler; Uterine Artery; Uterine Artery Embolization; Uterine Balloon Tamponade; Uterine Hemorrhage; Uterus

To describe the rates of use and effectiveness of gonadotropin-releasing hormone (GnRH) agonists and other forms of hormonal menstrual suppression in prevention of vaginal bleeding among young women who underwent hematopoietic stem cell transplantation (HCT).. Retrospective descriptive study.. University-based pediatric HCT practice.. Fifty-five postmenarchal women who underwent HCT between 2004 and 2011.. Administration of GnRH agonists or other forms of hormonal menstrual suppression.. Rates of use of GnRH agonists and other forms of hormonal menstrual suppression, and rates and descriptions of vaginal bleeding.. Forty-six of the 55 patients had experienced regular or irregular vaginal bleeding before HCT and were considered to be at risk for thrombocytopenia-associated menorrhagia. Forty of the 46 (87%) received hormonal menstrual suppression. Thirty-three patients were treated with a GnRH agonist, 4 with combined hormonal contraceptive pills, 1 with a combined hormonal contraceptive patch, 1 with depot medroxyprogesterone, and 1 with oral norethindrone. Twenty-nine of the 33 patients (88%) who received a GnRH agonist had complete amenorrhea during HCT and 4 of 33 (12%) experienced some degree of vaginal bleeding.. GnRH agonists appear effective in prevention of vaginal bleeding complications in most postmenarchal women who underwent HCT. Some patients who might benefit do not receive a GnRH agonist and multiple barriers exist in identification and treatment of them.

Topics: Adolescent; Adult; Amenorrhea; Child; Contraceptive Agents, Female; Female; Gonadotropin-Releasing Hormone; Goserelin; Hematopoietic Stem Cell Transplantation; Humans; Leuprolide; Preoperative Care; Retrospective Studies; Treatment Outcome; Uterine Hemorrhage; Young Adult

Uterine arteriovenous malformations are a rare and potentially life-threatening condition. Medical therapy has not been popular because of the propensity for excessive bleeding in the patient. As a result, the effect of gonadotropin-releasing hormone (Gn-RH) agonists on uterine arteriovenous malformations has not been established.. A 30-year-old patient presented with persistent vaginal bleeding. Based on the color Doppler ultrasound and magnetic resonance imaging findings, a uterine arteriovenous malformation was diagnosed. Because initial treatment with methylergonovine maleate was unsuccessful, the patient was treated with Gn-RH agonists. The lesion completely disappeared after 6 months of Gn-RH agonist treatment. Five months after the completion of Gn-RH agonist therapy, the patient conceived spontaneously and successfully completed a normal pregnancy. The patient has remained free from recurrence of the lesion.. Gonadotropin-releasing hormone agonist therapy has the potential to be a conservative treatment modality for uterine arteriovenous malformations in hemodynamically stable patients.

Topics: Adult; Arteriovenous Malformations; Female; Gonadotropin-Releasing Hormone; Humans; Leuprolide; Magnetic Resonance Imaging; Methylergonovine; Pregnancy; Treatment Outcome; Ultrasonography, Doppler, Color; Uterine Hemorrhage; Uterus

The effect of gonadotropin-releasing hormone agonist (GnRHa) on uterine arteriovenous malformations (AVM) is not well known.. A 37-year-old woman with a previous cesarean was diagnosed as having a uterine AVM after a spontaneous abortion with massive vaginal bleeding. The AVM decreased in size from 5.1 x 3.8 cm to 1.4 x 1.0 cm after 6 months of therapy with a GnRHa. Uterine artery embolization conducted after the GnRH therapy resulted in complete disappearance of the AVM. The patient's menstrual cycles and ovulation resumed 3 months after uterine artery embolization.. Gonadotropin-releasing hormone agonist therapy reduced the size of the uterine AVM. Thus, GnRHa therapy may be useful for uterine AVM in situations where uterine artery embolization must be postponed.

Topics: Abortion, Spontaneous; Adult; Arteriovenous Malformations; Chorionic Gonadotropin; Embolization, Therapeutic; Female; Humans; Leuprolide; Magnetic Resonance Imaging; Pregnancy; Ultrasonography; Uterine Hemorrhage; Uterus

To evaluate the efficiency and side-effects of depot medroxyprogesterone acetate in the treatment of moderate or severe endometriosis after conservative surgery.. Ninety-four women with moderate or severe endometriosis after conservative surgery were divided into three groups: 34 cases in the group of depot medroxyprogesterone acetate (DMPA) received intramuscularly depot medroxyprogesterone acetate 150 mg every 28 - 30 days for 6 months; 30 cases in the group of gonadotropin releasing hormone agonists (GnRH-a) received hypodermically leuprorelin acetate 3.75 mg every 28 - 30 days for 6 months; 30 cases in the group of control did not receive any postoperative medical treatment. Patients' symptoms and signs including pelvic pain, pelvic tenderness, menstrual and weight changes were recorded before and after treatment. Liver and renal functions, sex hormone level were also examined at the same time.. Both DMPA and GnRH-a treatment achieved similar significant relief of pelvic symptoms and signs (88% and 93%) compared with the control group (chi(2) = 12.273, P < 0.01; chi(2) = 9.604, P < 0.01). The cumulative recurrence rates of DMPA and GnRH-a groups were 6% and 7%, significantly lower than that of the control group (chi(2) = 5.222, P < 0.05; chi(2) = 4.320, P < 0.05). There were no significant differences between DMPA and GnRH-a groups (chi(2) = 0.488, P > 0.05; chi(2) = 0.017, P > 0.05). Serum estradiol (E(2)) level was significantly reduced in both DMPA and GnRH-a groups, but serum E(2) was maintained at the level of early follicular phase in the group of DMPA (120 +/- 9) pmol/L and menopause phase level in the group of GnRH-a (62 +/- 9) pmol/L. The main side effects of DMPA were menstrual changes, weight gain and delay of ovulation.. Depot medroxyprogesterone acetate seems to be an effective, safe, and convenient treatment for endometriosis with low-cost, good compliance, and few side effects.

Topics: Adult; Combined Modality Therapy; Delayed-Action Preparations; Drug Administration Schedule; Endometriosis; Estradiol; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Laparoscopy; Leuprolide; Luteinizing Hormone; Medroxyprogesterone Acetate; Treatment Outcome; Uterine Hemorrhage

Topics: Antineoplastic Agents, Hormonal; Blood Loss, Surgical; Double-Blind Method; Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Leuprolide; Randomized Controlled Trials as Topic; Uterine Hemorrhage

Prevention of uterine bleeding after stem cell transplantation was attempted in 30 consecutive premenopausal women affected by hematological malignancies. This was with luteinizing hormone-releasing hormone (LHRH) leuprorelin acetate depot 3.75 mg administered subcutaneously at least 30 days before the conditioning regimen and then 28 days after the first dose. Complete prevention resulted in all but one patient (96.5%) during the phase of profound thrombocytopenia. No side-effects related to leuprorelin were observed. All patients developed amenorrhea after transplantation. Gonadal function was periodically assessed by means of luteinizing hormone (LH), follicular stimulating hormone (FSH) and estradiol serum levels. Hormone levels were consistent with menopause in all patients. After transplantation, patients required hormone replacement with estroprogestinics or estrogens alone when indicated. Leuprorelin is highly effective in preventing uterine bleeding in premenopausal women undergoing stem cell transplantation and has an excellent toxicity profile and virtually no interface with hemostatic balance and hepatic function. The role of leuprorelin in gonadal protection is currently unclear and deserves further investigations.

Topics: Adolescent; Adult; Female; Hematologic Neoplasms; Hematopoietic Stem Cell Transplantation; Humans; Leuprolide; Middle Aged; Uterine Hemorrhage

To evaluate, in a pilot study, the use and efficacy of a gonadotropin-releasing hormone (GnRH)-agonist in inducing amenorrhea in women undergoing BMT.. We evaluated the use of the GnRH agonist leuprolide acetate (LA) for the induction of amenorrhea in 10 postmenarcheal women prior to BMT. If there was a contraindication to the use of the intramuscular (i.m.) formulation of LA, the subcutaneous (s.c.) formulation was given as a daily intravenous (i.v.) bolus. Once the subject's platelet count was > 50,000/microL, the LA was discontinued. Menstrual bleeding, time from initiation of therapy to amenorrhea, and liver function test results were monitored.. All subjects had induction of amenorrhea with the use of LA except for one subject with a large, myomatous uterus, who experienced light spotting. One subject who was thrombocytopenic at the prescribed time of the second dosage of i.m. LA received i.v. LA with documentation of continued pituitary/gonadal suppression. No adverse effects were determined to be directly related to either the i.m. or i.v. LA.. LA is an option for the induction of amenorrhea in postmenarcheal women undergoing BMT. In thrombocytopenic subjects, administration of the s.c. formulation of LA by an i.v. route served as an alternative to i.m. injection and was documented to maintain gonadotropin suppression.

Topics: Adolescent; Adult; Amenorrhea; Bone Marrow Transplantation; Contraindications; Female; Humans; Injections, Intramuscular; Injections, Intravenous; Leukemia; Leuprolide; Lymphoma; Pilot Projects; Platelet Count; Uterine Hemorrhage

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

An unsuspected primary cervical lymphoma thought to be a cervical fibroid decreased in size dramatically after initiation of Leuprolide acetate prior to being correctly diagnosed during subsequent hysterectomy for uterine bleeding. This case represents the first reported successful use of Leuprolide acetate against a reticuloendothelial tumor.

Topics: Adult; Diagnosis, Differential; Female; Humans; Hysterectomy; Leiomyoma; Leuprolide; Lymphoma; Uterine Cervical Neoplasms; Uterine Hemorrhage

Cervical pregnancy is rare but one of the most dangerous of all pregnancy complications. The aetiology of cervical implantation is unclear and because of the fear of profuse haemorrhage abdominal hysterectomy has been historically considered the standard therapy. We report here an unusual case of an infertile woman with cervical ectopic pregnancy after ovulation induction with gonadotrophins and intrauterine insemination. The patient was successfully treated with parenteral methotrexate without significant morbidity. It is concluded that chemotherapy should be initially considered in most cervical pregnancies either as the sole form of treatment or to improve the chances of success in alternative conservative measures.

Topics: Adult; Cervix Uteri; Female; Follicle Stimulating Hormone; Humans; Infertility, Male; Insemination, Artificial; Leuprolide; Male; Methotrexate; Ovulation Induction; Pregnancy; Pregnancy, Ectopic; Uterine Hemorrhage

In order to improve the success of endometrial ablation for uncontrolled uterine bleeding, a variety of preoperative agents were utilized. Patients were given either no preparation, progestins, danazol or leuprolide acetate depot as preoperative therapy to determine the best way to increase the incidence of amenorrhea and to decrease the failure rates. The lowest rates were achieved with danazol or no preparation, with amenorrhea rates of 41 and 43%, respectively. The highest rates were obtained with the use of either progestins or leuprolide acetate depot, 61 and 67%, respectively. Progestin use was discontinued early in the study because of side effects, resulting in numbers too low for accurate comparison. We concluded that the use of leuprolide acetate depot in a single-dose regimen resulted in the highest amenorrhea rates, with minimal or no side effects.

Topics: Adult; Danazol; Electrocoagulation; Endometrium; Female; Follow-Up Studies; Gynecology; Humans; Leuprolide; Premedication; Progesterone Congeners; Treatment Outcome; Uterine Hemorrhage

Acute vaginal bleeding secondary to uterine myomas can be a devastating event. We report the use of a combined therapeutic approach in a patient who presented with protracted bleeding of a myomatous uterus that was equivalent in size to a 38 week gestation. This patient's course was further complicated by her refusal of blood or blood products.

Topics: Acute Disease; Adult; Anemia; Combined Modality Therapy; Contraceptives, Oral, Synthetic; Drug Therapy, Combination; Estrogens, Conjugated (USP); Female; Hematocrit; Humans; Injections, Subcutaneous; Leiomyoma; Leuprolide; Preoperative Care; Tampons, Surgical; Time Factors; Treatment Refusal; Uterine Hemorrhage; Uterine Neoplasms

Recurrence of heavy vaginal bleeding and massive necrosis of a uterine leiomyosarcoma are reported in a 41-year-old female who was being treated with GnRH-a for a presumed uterine fibroid. The pathogenic mechanisms of such an event are reviewed and discussed in light of the available literature on the subject of GnRH-a and the treatment of uterine smooth muscle neoplasms.

Topics: Adult; Female; Humans; Leiomyosarcoma; Leuprolide; Necrosis; Uterine Hemorrhage; Uterine Neoplasms; Uterus

Gonadotropin releasing hormone agonists are often used in the management of myomas in an attempt to decrease both the myoma and uterine volume. This therapy in a woman with submucous myomas resulted in profuse vaginal bleeding requiring a transfusion and myomectomy.

Topics: Adult; Blood Transfusion; Female; Humans; Leiomyoma; Leuprolide; Uterine Hemorrhage; Uterine Neoplasms