A Randomized, Double-Blind Trial of a Gonadotropin-Releasing Hormone Agonist (Leuprolide) with or without Medroxyprogesterone Acetate in the Treatment of Leiomyomata Uteri

Friedman, Andrew J.; Barbieri, Robert L.; Doubilet, Peter M.; Fine, Calliope; Schiff, Isaac

doi:10.1097/00006254-198808000-00019

Cited by 53 publications

(73 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Furthermore, regression of uterine leiomyomata has been induced by treatment with the antiprogesterone drug RU 486, accompanied by reduction in the progesterone receptor (PR) but not the ER in the tumors, suggesting that the regression was attained through a direct antiprogesterone effect (Murphy et al 1993). In addition patients treated with leuprolide (a GnRH agonist capable of reducing the size of fibroids) who were concomitantly given medroxyprogesterone acetate demonstrated no significant reduction in myoma or uterine volume (Carr et al 1993;Friedman et al 1988). Indeed, clinical and laboratory evidence to date would appear to indicate that estrogen and progesterone may both be important as promoters of myoma growth (Rein 2000).…”

Section: Clinical Observationsmentioning

confidence: 99%

Etiology and pathogenesis of uterine leiomyomas: a review.

Flake

Andersen

Dixon

2003

Environ Health Perspect

494

392

View full text Add to dashboard Cite

Uterine leiomyomas, or fibroids, represent a major public health problem. It is believed that these tumors develop in the majority of American women and become symptomatic in one-third of these women. They are the most frequent indication for hysterectomy in the United States. Although the initiator or initiators of fibroids are unknown, several predisposing factors have been identified, including age (late reproductive years), African-American ethnicity, nulliparity, and obesity. Nonrandom cytogenetic abnormalities have been found in about 40% of tumors examined. Estrogen and progesterone are recognized as promoters of tumor growth, and the potential role of environmental estrogens has only recently been explored. Growth factors with mitogenic activity, such as transforming growth factor-β 3, basic fibroblast growth factor, epidermal growth factor, and insulin-like growth factor-I, are elevated in fibroids and may be the effectors of estrogen and progesterone promotion. These data offer clues to the etiology and pathogenesis of this common condition, which we have analyzed and summarized in this review.

show abstract

Section: Clinical Observationsmentioning

confidence: 99%

Etiology and pathogenesis of uterine leiomyomas: a review.

Flake

Andersen

Dixon

2003

Environ Health Perspect

494

392

View full text Add to dashboard Cite

show abstract

“…Though an insufficient dosage of nafarelin with hormone add-back therapy may explain that total failure of leiomyoma shrinkage in our patients, it appears that hormone add-back with oestrogen and progestin may also be unfavourable as regards leiomyomal shrinkage. Previously, medroxy-progesterone acetate simultaneously with GnRHa has been observed to block leiomyomal shrinkage [10]. Further, we have earlier reported that in postmenopausal leiomyomas, oestrogen replacement therapy alone increased cell proliferation less than did hormone substitution therapy with simultaneous oestrogen and progestin [5].…”

Section: Discussionmentioning

confidence: 89%

“…Simultaneous medroxyprogesterone acetate with GnRHa has been observed to reduce side effects but also to block the expected leiomyomal decrease in size [10]. However, GnRHa treatment followed by replacement therapy with oestrogen and progestin brought about a decrease in hypo-oestrogenic symptoms and also in most cases brought about leiomyomal shrinkage [11,12].…”

Section: Discussionmentioning

confidence: 99%

GnRH Analogues and Uterine Leiomyomas

Rintala

Kujansuu²,

Teisala³

et al. 1999

Gynecol Obstet Invest

View full text Add to dashboard Cite

Cell proliferation in uterine leiomyomas treated preoperatively with either nafarelin (400 μg/day) for 3 months (7 patients) or nafarelin plus hormone (oestradiol + norethisterone) add-back therapy (6 patients) was investigated by automatic image analysis of frozen tissue sections using immunohistochemistry with anti-proliferating cell nuclear antigen antibody. GnRHa therapy decreased cell proliferation in leiomyomas to a level corresponding to the situation previously seen in postmenopausal leiomyomas. However, there was no consistent correlation between cell proliferation and shrinkage of leiomyomal size. The hormone add-back therapy moderated the influence of GnRHa on cell proliferation and completely blocked a decrease in size of leiomyomas in our patients.

show abstract

“…Progestins alone have been employed to suppress vasomotor symptoms and bone mineral density loss in both patient groups. In leiomyoma patients, MPA when combined with leuprolide acetate eliminated vasomotor symptoms induced by GnRH-a but unfortunately neutralized the suppressive effect of the agonist on the reduction of tumor size [7,8]. A similar undesired effect was noted in endometriosis patients whose pain appeared to worsen and disease failed to resolve during combination therapy using MPA in daily doses of 20-30 mg [9].…”

Section: Role Of Add-back Therapy In Gynecologymentioning

confidence: 99%

Add-Back Therapy: Extending Safety and Efficacy of GnRH Analogues in the Gynecologic Patient

Surrey¹

1998

Gynecol Obstet Invest

View full text Add to dashboard Cite

GnRH analogues have been demonstrated to be effective medical therapy for symptomatic endometriosis. The use of these agents has been limited to 6 months due to hypoestrogenic side effects. A variety of steroidal and nonsteroidal add-back regimens have been used in an effort to eliminate such side effects while maintaining efficacy in order to enhance compliance, safety and duration such side effects while maintaining efficacy in order to enhance compliance, safety and duration of administration of these agents. Only 3 regimens have been shown to be efficacious in prolonging analogue use beyond 6 months by reducing vasomotor symptoms as well as preventing significant bone mineral density loss. These include daily norethindrone acetate 5 mg alone or in conjunction with conjugated equine estrogens 0.625 mg daily, as well as norethindrone 2.5 mg daily in conjunction with an organic bisphosphonate. With further investigation, such regimens may allow safe prolongation of GnRH analogue use without sacrificing efficacy in those endometriosis patients with severe pelvic pain.

show abstract

A Randomized, Double-Blind Trial of a Gonadotropin-Releasing Hormone Agonist (Leuprolide) with or without Medroxyprogesterone Acetate in the Treatment of Leiomyomata Uteri

Cited by 53 publications

References 0 publications

Etiology and pathogenesis of uterine leiomyomas: a review.

Etiology and pathogenesis of uterine leiomyomas: a review.

GnRH Analogues and Uterine Leiomyomas

Add-Back Therapy: Extending Safety and Efficacy of GnRH Analogues in the Gynecologic Patient

Contact Info

Product

Resources

About