The combination of a depot gonadotrophin releasing hormone agonist and cyclical hormone replacement therapy for dysfunctional uterine bleeding

Abstract

Objective— To observe if a combination of a depot GnRH agonist and cyclical hormone replacement therapy decreases menstrual b od loss. Design— open, observational study comparing the objective assessment of menstrual blood loss before, during and after 3 months treatment. Subjects— 20 women with a subjective complaint of heavy menstrual loss in whom no cause could be discovered. Interventions— Each woman received 3 months of depot goserelin (Zoladex) combined with cyclical hormone replacement therapy (Cyclo‐Progynova, 1 mg). Menstrual loss and symptoms were assessed before, throughout and after the study. Main outcome measures— Changes in objective and subjective assessments of menstrual blood loss and the acceptability of the treatment. Results— The median pretreatment menstrual loss was 68 ml (range 23–397). Only 8 (40%) of the patients had a loss exceeding 80 ml per period. The median blood loss was 30 ml, 16 ml, and 17 ml in the three treatment cycles (P < 0.001 Wilcoxon rank sum for the third cycle). There was a significant decrease in the median length of menstruation (P < 0.001) and the number of towels or tampons (P < 0.01) used per period in the third treatment cycle. There was a significant decrease (P < 0.005) in the number of women complaining of dysmenorrhoea, premenstrual symptoms, flooding and the passage of clots. Seventeen patients experienced hot flushes. Eighteen of the 20 patients were completely satisfied with the treatment and would have been happy to continue with it for longer than 12 months. Conclusions— The combination of a depot gonadotrophin releasing hormone agonist and cyclical hormone replacement therapy is a successful and acceptable treatment of dysfunctional uterine bleeding.

Menorrhagia: an update

“…Concerns about bone loss and poor tolerability of GnRH agonists have led to a number of studies on estrogen and progestogen ‘addback therapy’ during GnRH agonist treatment. When cyclical estrogen/progestogen hormone replacement therapy has been used in conjunction with GnRH analogs the annoying side‐effects of GnRH agonist treatment are minimized without affecting the control of dysfunctional menstrual bleeding (116).…”

Zoladex® (goserelin) in the treatment of benign gynaecological disorders: an overview of safety and efficacy

“…Studies in patients with dysfunctional uterine bleeding have shown that symptoms and menorrhagia are reduced by Zoladex treatment but recur after cessation of therapy 7–9 . Patients with polycystic ovary syndrome have demonstrated cyst and serum testosterone reduction 10 .…”

Can hormone replacement therapy be used during medical therapy of endometriosis?

“…The addition of HRT means, however, that long‐term treatment is a possibility for young women with recurrent endometriosis, thus avoiding surgery and loss of fertility before pregnancy, when desired, has been attained. The treatment of other menstrual disorders, such as menorrhagia, which cannot always be controlled with current conventional therapy 12 , also becomes a possibility and could avoid the need for hysterectomy and the denial of fertility to young patients. Finally, as GnRH agonists have been shown to reduce fibroid size, such treatment becomes a possibility in young women with fibroids, thus avoiding the need for surgery and loss of fertility.…”