Treatment with a luteinising hormone-releasing hormone analogue (Buserelin) in danazol-resistant endometriosis patients

Results of insemination (AIH) following GnRH treatment of endometriosis

Endometriosis is one of the most frequent benign diseases in gynecology. It is the cause of the pelvic pain and infertility in more than 35% of women of reproductive age. The most appropriate treatment for endometriosis is the combination of surgery and adjuvant medical therapy with GnRH agonists. The authors demonstrate the results of 33 artificial intrauterine homolog inseminations after a 6-month GnRH analog therapy.

Treatment of endometriosis with a delayed release preparation of the agonist D-Trp6-luteinizing hormone-releasing hormone: long-term follow-up in a series of 50 patients

Fifty patients with proven endometriosis were treated for 6 to 9 months with a delayed release preparation of microcapsules of the luteinizing hormone-releasing hormone (LH-RH) agonist D-Trp6-LH-RH, injected intramuscularly at monthly intervals. After a transitory ovarian stimulation at the onset of treatment, serum estradiol was suppressed to menopausal levels (50 pg/mL). This state of hypogonadism was reversible after the discontinuation of treatment, and menses resumed within 4 months after the last injection. Pelvic pain was relieved during treatment in 87.5% of patients. After a follow-up period of up to 37 months, 24 patients are in clinical remission and 9 experienced recurrence of endometriosis 7 to 14 months after completing treatment. One patient failed to respond to therapy with the agonist and 7 patients were lost to follow-up. Among 16 previously infertile patients with no other factors contributing to infertility, 7 became pregnant; 2 of these pregnancies were the result of gamete intrafallopian transfers. An eighth patient without documented infertility also conceived spontaneously. Side effects due to hypoestrogenism were reported by nearly all patients. In conclusion, D-Trp6-LH-RH microcapsules are effective and easily-administered agents for the treatment of endometriosis.

Buserelin. A review of its pharmacodynamic and pharmacokinetic properties, and clinical profile

The gonadotrophin releasing hormone (GnRH) [luteinising hormone-releasing hormone (LHRH); gonadorelin] agonist buserelin is a promising new agent in the treatment of a variety of disorders in gynaecology and andrology, paediatrics and oncology. While a single dose of buserelin stimulates the release of pituitary gonadotrophins, multiple doses produce reversible pituitary desensitisation, and this specific blockade of gonadotrophin support to the gonads provides the basis for the drug's efficacy in conditions dependent on sex hormone secretion. Thus, buserelin provides comparable efficacy to orchidectomy or high dose estrogens in the treatment of hormone-sensitive prostate cancer and exhibits a lower incidence of adverse effects. During the early phase of treatment it may be particularly useful in combination with antiandrogens. Buserelin also appears promising in hormone-sensitive premenopausal breast cancer. Extensive studies have proven the value of buserelin in endometriosis, where it produces a transient remission with gradual recurrence of the disease on cessation of treatment. Surgical intervention is necessary in severe disease after buserelin-induced involution of the lesions. In patients with uterine leiomyoma, preliminary data suggest that buserelin may be beneficial in rendering surgery more conservative by reducing fibroid size, although it appears unlikely to preclude surgical intervention. The use of buserelin to induce a state of reversible hypogonadotrophism before administration of exogenous gonadotrophins is a promising strategy in the treatment of infertility associated with polycystic ovary syndrome and other conditions of infertility with underlying ovarian dysfunction; such a strategy also clearly enhances the efficiency of in vitro fertilisation programmes. Initial studies suggest its potential usefulness as a female contraceptive when administered intermittently in conjunction with a progestogen. Buserelin represents a first-line treatment of central precocious puberty. In endometriosis the adverse effect profile of buserelin is generally favourable, with hypoestrogenic effects such as hot flushes and vaginal dryness, and decreased libido, predominating. There is no apparent detrimental effect on lipid metabolism. The potential for adverse hypoestrogenic effects on bone mineral content with long term administration remains to be clarified. Thus, the GnRH agonist buserelin represents an advance in the treatment of a variety of gynaecological and andrological as well as paediatric and oncological conditions, infertility and other sex-hormone dependent conditions, with a low incidence of adverse treatment effects.

Endometriosis: treatment with gonadotropin-releasing hormone agonist Buserelin

Fifty-one women with pelvic endometriosis were treated with the gonadotropin-releasing hormone agonist (GnRHa) Buserelin (Hoechst Holland N.V., Amsterdam, The Netherlands) 300 micrograms three times a day intranasally for 6 months. Forty-nine women completed treatment; 42 were available for 6 months of follow-up following treatment. Symptoms showed prompt and significant improvement. Follow-up after treatment revealed persistent relief from dysmenorrhea and dyspareunia in, respectively, 58.6% and 88.2% of the women, whereas pelvic pain returned to pretreatment scores. Serum estradiol (E2) was suppressed to predominantly early follicular phase concentrations. Laparoscopy at the end of therapy showed significant reduction of scores for implants only. There was no relation between the degree of E2 suppression during therapy and the improvement of symptoms or the reduction of endometriosis. Statistical analysis in 22 infertile patients, of whom 7 conceived during follow-up, revealed no differences in E2 levels during therapy, improvement of symptoms, or reduction of endometriosis. Buserelin appears to be safe, well tolerated, and effective in the management of endometriosis and associated complaints.