The effect of danazol on pulsatile gonadotropin secretion in women with endometriosis

Study on the Mechanism of Sarsasapogenin in Treating Precocious Puberty by Regulating the HPG Axis

The present study aims to investigate the effects and mechanisms of sarsasapogenin resistance to precocious puberty. Female Sprague Dawley rats were divided into a normal (N) group, model (M) group, leuprolide (L) group, and sarsasapogenin (Sar) group. Rats at 5 days of age were given a single subcutaneous injection of 300 micrograms of danazol to establish the precocious puberty model. After 10 days of modeling, drug intervention was started. The development of the uterus and ovary was observed by hematoxylin and eosin (HE) staining. The levels of the serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estradiol (E2) were determined by radioimmunoassay. Also, the expressions of the hypothalamic gonadotropin releasing hormone (GnRH), Kiss-1, G protein-coupled receptor 54 (GPR54), and pituitary gonadotropin releasing hormone receptor (GnRH-R) were detected by RT-PCR. The results showed that compared with the model group, sarsasapogenin could significantly delay the opening time of vaginal, decreased uterine and ovarian coefficients, and reduced uterine wall thickness. Moreover, it can significantly downregulate the levels of serum hormones and reduce the expression of GnRH, GnRH-R, and kiss-1. In summary, our results indicate that sarsasapogenin can regulate the HPG axis through the kiss-1/GPR54 system for therapeutic precocious puberty.

Long-Term Vaginal Danazol Treatment in Fertile Age Women with Adenomyosis

Background

The aim of the study was to evaluate the clinical efficacy of long-term vaginal danazol treatment in fertile age women with adenomyosis on pain symptoms and abnormal uterine bleeding (AUB).

Methods

A retrospective study on 66 young women with dysmenorrhea and/or dyspareunia, AUB and 2D-ultrasound diagnosis of adenomyosis was conducted at University Hospital of Siena (Italy). Women included were treated with a daily low-dose vaginal danazol (200 mg) for 6 months, followed by 2 different schedules: group A) continuous treatment for further 18 months (n = 30); group B) cyclic intermittent treatment with 3 months’ therapy followed by 3 months’ interval for further 18 months (n = 36). A visual analog scale (VAS) for pain symptoms, a pictorial blood-loss assessment chart (PBAC) for uterine bleeding, 2D-ultrasound signs of adenomyosis and quality-of-life measures were assessed at baseline and after both vaginal progestin regimens.

Results

The pain symptoms, PBAC score and uterine volume were significantly reduced (p<0.0001) after 6 months, and the reduction persisted in both group of patients until the end. Mental and physical index score values increased (p<0.0001) in both groups at the end of treatment, with significantly higher mental index scores in intermittent than in continuous treatment (p<0.0001), associated with some drop-out (10%).

Conclusions

A long-term treatment with vaginal danazol is effective to control pain and AUB in women with adenomyosis. The 6 months’ treatment followed by a cyclic 3 months’ treatment for further 18 months has the best compliance in symptomatic patients with adenomyosis.

Efficacy of vaginal danazol treatment in women with recurrent deeply infiltrating endometriosis

OBJECTIVE

To describe a safe long-term medical treatment for deeply infiltrating endometriosis, a critical condition characterized by multiple painful symptoms and a high recurrence rate after surgical treatment.

DESIGN

Prospective study.

SETTING

University of Siena.

PATIENT(S)

Twenty-one women with deeply infiltrating endometriosis.

INTERVENTION(S)

In a nonrandomized prospective study a low dose of vaginal danazol (200 mg/d) was self-administered for 12 months. After a previous laparoscopic surgery, these patients had reported recurrent severe dyspareunia, dysmenorrhea, and pelvic pain (in five cases also painful defecation).

MAIN OUTCOME MEASURE(S)

Before and every 3 months during the treatment a visual analogue pain scale was used. Transvaginal and transrectal ultrasound examinations were performed before and after 6 and 12 months of treatment. Adverse effects were registered, and serum concentration of cholesterol, triglycerides, aspartate aminotransferase, alanine aminotransferase, glycemia, protein S, protein C, antithrombin III, and homocysteine was evaluated before and after 12 months.

RESULT(S)

Dysmenorrhea, dyspareunia, and pelvic pain significantly decreased within 3 months and disappeared after 6 months of treatment, with a persistent effect during the 12 months of treatment. A relief of painful defecation was also shown. Ultrasound examination showed a reduction of the nodularity in the rectovaginal septum within 6 months. The medical treatment did not affect metabolic or thrombophilic parameters; few local vaginal adverse effects were reported.

CONCLUSION(S)

Vaginal danazol resulted in effective medical treatment for the various painful symptoms in women with recurrent deeply infiltrating endometriosis, and because of the lack of significant adverse effects it may be proposed as an alternative to repeated surgery.

Danazol concentrations in ovary, uterus, and serum and their effect on the hypothalamic-pituitary-ovarian axis during vaginal administration of a danazol suppository

OBJECTIVE

To determine danazol concentrations in the ovary, uterus, and serum during daily vaginal administration of a danazol suppository and to examine its effect on the hypothalamic-pituitary-ovarian axis.

DESIGN

Sampling of tissues after vaginal or oral administration of danazol and sampling of blood during control and danazol-administration menstrual cycles.

SETTING

Outpatient volunteers and inpatients at a public hospital.

PARTICIPANTS

Thirty patients who were to undergo hysterectomy and oophorectomy because of uterine leiomyoma and eight regularly menstruating volunteers.

INTERVENTIONS

Danazol was administered as a vaginal suppository (100 mg) or orally (400 mg).

MAIN OUTCOME MEASURE

Danazol concentrations in the ovary, uterus, and serum, and serum E2 and P levels.

RESULTS

Danazol concentrations in the ovary and uterus after daily vaginal administration of a suppository containing 100 mg danazol were comparable to those after daily oral administration of 400 mg danazol, but the serum danazol concentration was much lower. Menstrual cycle patterns of serum E2 and P levels were normal during daily vaginal administration of a danazol suppository.

CONCLUSION

Daily administration of a suppository containing 100 mg danazol produces high ovarian and uterine concentrations but low serum concentrations, and no effect was detected on the hypothalamic-pituitary-ovarian axis.

Danazol influences gonadotropin secretion acting at the hypothalamic level

OBJECTIVES

The purpose of the study was to determine the influence of danazol on gonadotropin secretion.

METHODS

Ten endometriotic patients were treated with danazol for 6 months. To evaluate gonadotropin and estradiol secretion, a gonadotropin-releasing hormone (GnRH) test and a clomiphene citrate (CC) challenge test were carried out in the follicular phase before treatment, during the sixth month of treatment and after the reappearance of the second menses. The same tests were also performed, only once, in the follicular phase of ten normal women.

RESULTS

GnRH-stimulated gonadotropin response during danazol treatment was significantly higher than that in the same group of women before and after danazol treatment, as well as in controls. Gonadotropin increase after clomiphene citrate administration during danazol treatment was not significant; moreover, LH response was significantly lower than that in the same group of patients before and after danazol treatment, as well as in controls.

CONCLUSIONS

Our results suggest that danazol exerts a suppressive effect on gonadotropin secretion acting at the hypothalamic level.

Induction of true precocious puberty by neonatal treatment with danazol in female rats

Female rats at 5 days of age were given a single subcutaneous injection of varying doses of danazol or vehicle. Rats treated with 300 micrograms of danazol showed significant (P < 0.01, respectively) advancement in the day of vaginal opening (37.50 +/- 0.49 days vs. 25.20 +/- 0.19 days; mean +/- S.E.M.), first estrus (38.19 +/- 0.62 days vs. 29.10 +/- 0.26 days) and onset of estrous cycle (49.63 +/- 1.30 days vs. 37.07 +/- 1.50 days). All rats treated with danazol showed 4- or 5-day estrous cycle in the adulthood. Rats treated with 300 micrograms of danazol at 5 days of age discharged luteinizing hormone in the late stage of first proestrus. These results demonstrate that neonatally administered danazol produces the true precocious puberty in female rats, and this sexual precocity rat represents a unique model for analysis of the onset of puberty.

Danazol in the treatment of menorrhagia: the effect of a 1 month induction dose (200 mg) and 2 month's maintenance therapy (200 mg, 100 mg, 50 mg or placebo)

This paper highlights the difficulties of recruiting subjects to objective menstrual blood loss (MBL) studies. Such difficulties may explain the relative paucity of such studies in the literature. Eleven women with objectively assessed evidence of menorrhagia were treated for 1 month with an induction dose of 200 mg of danazol (Danocrine). Subsequently the women were randomly assigned to receive 50, 100 or 200 mg of danazol or placebo for 2 months of maintenance dosing. Follow-up with objective assessment of MBL was continued for 3 months after cessation of maintenance dosing. Danazol 200 mg as an induction dose significantly reduced MBL. The maintenance dose of 200 mg during the following 2 months produced a further decrease in MBL and in some cases amenorrhoea. The lower maintenance dosages of 50 mg and 100 mg were associated with a variable response. The study was unable to determine whether any beneficial effect of the maintenance dosages of danazol could be maintained following cessation of therapy since the study numbers had become too small. It appears, however, that there is unlikely to be any persisting benefit once therapy has ceased.