Efficacy and safety considerations in women with uterine leiomyomas treated with gonadotropin-releasing hormone agonists: the estrogen threshold hypothesis
Article Abstract:
Uterine leiomyomas, also commonly called fibroid tumors, are noncancerous growths containing muscle tissue that are associated with anemia due to excessive bleeding and enlargement of the uterus. These tumors are estrogen-dependent, and blockade of estrogen and prevention of estrogen secretion are effective treatment methods. Gonadotropin-releasing hormone (GnRH) controls the release of hormones that regulate estrogen synthesis, and GnRH agonist analogs (i.e., which are chemically similar) effectively decrease estrogen secretion. GnRH analogs have decreased the size of fibroids and decreased anemia in studies, but these effects do not persist after the drug is discontinued. Also, the consequences of suppressing estrogens may be harmful. Amenorrhea (suppression of menstruation) usually occurs, and side effects associated with menopause such as flushing, insomnia, headaches, mood changes, and vaginal dryness may occur. In addition, osteoporosis may also occur. Studies of GnRH analog treatment of uterine leiomyomas and potential uses of the drug are reviewed in this article. Hysterectomy (removal of the uterus) is currently the only cure for leiomyomas, but complications such as blood loss and urologic injury occur. These complications are associated with size of the tumor, and presurgical treatment with GnRH agonists was associated in several studies with presurgical improvement in anemia and significantly less blood loss. In addition, it may improve the options available to the surgeon so that the least difficult or damaging techniques may be used. Preliminary studies have suggested that synthetic forms of progesterone and estrogen may be given with GnRH agonists to diminish harmful side effects. These ''add-back'' regimens seem to be effective because the estrogen doses needed to prevent hot flashes and bone loss are less than those needed to support the growth of fibroid tumors. More research is needed to ascertain the benefits and long-term effects and to optimize the protocols used in GnRH plus hormone add-back therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Obstetrics and Gynecology
Subject: Health
ISSN: 0002-9378
Year: 1990
User Contributions:
Comment about this article or add new information about this topic:
Progesterone: a critical role in the pathogenesis of uterine myomas
Article Abstract:
Progesterone may play a role in the growth and development of uterine myomas, benign tumors of the uterine muscle, as well as estrogen. Studies have shown that more cells within the myoma were dividing during exposure to progesterone during the last third of the menstrual cycle, or among postmenopausal women taking progesterone, or in cell culture as compared with low or no progesterone exposure. Women taking progesterone show tumor enlargement, which subsides when the medication is stopped. The relationship between uterine myomas and sex hormones appears to be more complex than previously suspected. Progesterone appears to increase cell division among tumor cells, which in turn propagates the genetic abnormalities that distinguish the tumor from normal cells. How progesterone exerts its effect is not known, but there are plausible theories for which at least some evidence exists.
Publication Name: American Journal of Obstetrics and Gynecology
Subject: Health
ISSN: 0002-9378
Year: 1995
User Contributions:
Comment about this article or add new information about this topic:
Should uterine size be an indication for surgical intervention in women with myomas?
Article Abstract:
Whether a woman with a fibroid uterus should undergo surgery should be based on the severity of her symptoms and not merely on the size of the uterus. The American College of Obstetricians and Gynecologists recommends hysterectomy for women with fibroid uterus once the uterus is the size seen at 12 weeks gestation. Tumor removal is advocated once the uterus reaches that size in women under 40 who want to preserve fertility. However, the reasons usually cited for this policy - that otherwise the ovaries cannot be assessed, malignancy cannot be ruled out and other organs may be damaged - are from a time before ultrasound testing became available. Hysterectomies are associated with significant rates of death and severe complications. With regular check-ups and annual ultrasound tests, women with an asymptomatic fibroid uterus need not automatically undergo hysterectomy.
Publication Name: American Journal of Obstetrics and Gynecology
Subject: Health
ISSN: 0002-9378
Year: 1993
User Contributions:
Comment about this article or add new information about this topic:
- Abstracts: Plasma homocysteine concentration is increased in preeclampsia and is associated with evidence of endothelial activation
- Abstracts: Circulating angiogenic proteins in trisomy 13. The puzzling association between smoking and hypertension during pregnancy
- Abstracts: Transferring patients with a urinary catheter. 'Nurses are in an excellent position to assist their patients with living wills'
- Abstracts: Efficacy of pamidronate in reducing skeletal events in patients with advanced multiple myeloma. Lenalidomide plus dexamethasone for relapsed or refractory multiple myeloma
- Abstracts: Brief report: resistance to thyrotropin caused by mutations in the thyrotropin-receptor gene. Brief report: congenital hyperthyroidism caused by a mutation in the thyrotropin-receptor gene