LRH agonist buserelin as a post-partum contraceptive: lack of biological activity of buserelin in breast milk

Study of enteral versus parenteral application of the gonadotropin releasing hormone agonist Gonadorelin[6-D-Phe] (D-Phe6-LHRH) on LH secretion in Goettinger miniature pigs

With respect to the assessment of residue situation and as a part of preclinical trials to determine the biological activities of potential gonadotropin releasing hormone (GnRH) residues in porcine organisms the GnRH agonist Gonadorelin[6-D-Phe] (D-Phe(6)-LHRH) was administered either enterally or intramuscularly (i.m.) to female Goettinger miniature pigs in order to evaluate the GnRH-induced luteinizing hormone (LH) surge. Gilts received an (i) enteral application of 10 mg D-Phe(6)-LHRH via a probang (enteral group, n=7), (ii) i.m. injection of 0.1 mg D-Phe(6)-LHRH (parenteral group, n=5), or (iii) saline injection (control group, n=4). The GnRH and saline applications were repeated every second day with up to seven repetitions. Blood samples were collected via previously fitted jugular catheters immediately before injections, over an 8 h period in 1 h intervals beginning 2 h after injections, and at 24, 26, 28 and 30 h after applications. Enteral application of D-Phe(6)-LHRH induced an LH surge in 23 of 30 treatments. All gilts in the parenteral group exhibited LH release after each D-Phe(6)-LHRH application (P<0.05), whereas no LH surges were observed after saline injection in the control group. A significant (P<0.05) LH rise to mean maximum LH concentrations of 3.25 +/- 0.43 and 3.05 +/- 0.26 ng/ml occurred in both the enteral and parenteral groups, but there was no difference in the time interval after GnRH (2.6 +/- 0.3 vs. 2.3 +/- 0.3 h) and the mean duration of LH peak (6.5 +/- 0.4 and 6.8 +/- 0.3 h) between the treatment groups. In conclusion, (i) enteral application of 10 mg D-Phe(6)-LHRH induced LH release in a physiological range from the pituitary of female minipigs, and (ii) neither an accumulative effect nor a cumulative LH response were found after repeated GnRH application. Furthermore, (iii) in regard to consumer protection and gonadotropin secretion, D-Phe(6)-LHRH residues can be excluded from having long-term effects.

Effects of oral buserelin on urinary LH secretion in male infants

In recent years, several potent gonadotropin-releasing hormone (GnRH) analogues have become available for female contraception and one of them (buserelin) has been tested in lactating women. However, the possible effects on infants due to the transference of the analogue through breast milk have not been studied. The present work evaluated the effect of oral buserelin on urinary LH secretion in male infants. A total of 19 healthy full-term boys (aged 2-4 months) were included in the study. Infants received orally a single dose of a GnRH agonist mixed with breast milk. Urine samples were collected prior to, and 4-6 and 24 h after treatment for LH measurement. The results disclosed a significant increase in LH urine level in the sample taken 4-6 h after buserelin administration. Twenty-four hours after GnRH agonist ingestion, the LH level returned to baseline level. The present study demonstrated that GnRH analogue administered orally to infants escapes from gastrointestinal inactivation and induces a significant rise in LH levels 4-6 h after treatment.

Luteinizing hormone releasing hormone agonist for postpartum contraception

OBJECTIVE

To compare the effects of a GnRH agonist upon ovarian function, bleeding pattern, and nursing practice in two groups of Mexican women during the postpartum period.

DESIGN AND PATIENTS

Two doses of a GnRH agonist (300-600 micrograms) were investigated during the postpartum period in fully breastfeeding mothers at 6 weeks postpartum. A total of 29 women who desired to breast feed for at least 6 months were allocated in three study groups; group I (control); group II, taking 300 micrograms; and group III, taking 600 micrograms.

RESULTS

After treatment initiation, an increase of estrone levels was observed among treated women; thereafter, irregular fluctuations of estrone levels were observed, mainly among women from group III. All the control women and two participants from group III ovulated during the study. Moderate bleeding was registered in most of the women from group I, while amenorrhea and spotting were observed in participants from groups II and III, respectively. There was no significant effect of the treatment on nursing practice between groups.

CONCLUSION

GnRH agonists have advantages over steroids for hormonal contraception during the postpartum period in breastfeeding women. Symptoms of hypoestrogenism were not reported any time in either the controls or the treated groups, as estrone levels were not suppressed to menopausal values. Once-daily administration of GnRH agonist could be a reliable, acceptable and safe contraceptive method during the postpartum period in breastfeeding women. More information is required to establish GnRH analog contraceptive efficacy.

Physiology of lactation

The development of the human breast is dependent on the presence of ovarian steroids. The basic secretory units--the alveoli--continue to respond to steroids throughout the reproductive years. Lactogenesis is triggered by a rapid and drastic fall in progesterone at delivery and maintained by prolactin while the actual expulsion of milk from the breast depends on oxytocin. The composition of milk is very variable but is adequate to provide the sole source of nutrients for up to the first 6 months of life. Lactation suppresses ovarian activity probably through a disturbance in the pulsatile pattern of LH secretion but the degree of suppression depends on infant feeding patterns and perhaps on maternal nutritional status. Breastfeeding therefore confers a degree of protection against pregnancy but some artificial methods of contraception are appropriate for use during lactation. It is still not clear whether breastfeeding protects significantly against breast cancer.

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.