Clinical and endocrine response to pulsatile intravenous gonadotropins in refractory anovulation

Article Abstract:

Infertility due to the lack of ovulation can sometimes be reversed by stimulation with the drug clomiphene citrate (an anti-estrogen drug) and gonadotropin releasing hormone (GnRH). The hormones that stimulate the production of estrogen (gonadotropins) are increased in the brain, estrogen production is stimulated, and ovulation is induced. Human menopausal gonadotropins are extracted from menopausal women with high levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), gonadotropins that induce ovulation. When intravenous human menopausal gonadotropin is given in a way that mimics the normal pattern of gonadotropin release, ovulation is induced. The clinical and hormonal effect that episodic administration of human menopausal gonadotropin has on the body is not known. The endocrine responses to human menopausal gonadotropin given every 90 to 120 minutes were studied in patients who did not respond to the two traditional methods of ovulation induction. FSH and LH were measured before and after a total of 107 treatment cycles were given to 30 nonovulating women. The women assigned to group I had very low estrogen production, while the women in group II had some estrogen, but normal FSH and LH levels. In four of the women in group I, ovulation occurred in all cycles. The pregnancy rate for each cycle was 63 percent and eventually all patients became pregnant. In the 26 patients classified as belonging to group II, 86 percent ovulated in a total of 99 cycles. The pregnancy rate for each cycle was 14 percent, and 56 percent eventually became pregnant. Swelling at the site of insertion of the intravenous catheter occurred in 24 percent of the treatment cycles. Episodic administration of human menopausal gonadotropin was effective in treating anovulatory women not responding to other methods of ovulation induction. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Gonadotropin, Gonadotropins, Infertility, Female, Female infertility, Anovulation

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The role and use of progestogens

Article Abstract:

For menopausal women, hormone replacement therapy with estrogen confers important health benefits, and progestogens (progestational hormones, another type of female hormone) are often prescribed in combination with estrogen. Progestogens are said to reduce the irregular bleeding that estrogen may cause; they protect against breast cancer; and they enhance estrogen's effect in preserving bone mass. However, the only progestogen effect that has been reliably documented is that of endometrial protection (against cancer). A comprehensive review of the effects of progestogens and of unopposed estrogens (without progestogens) is provided. The drugs are taken in sequence in the US, while estrogen is given continuously, with progestogen added for several days, in Europe. Dosages and dose schedules are evaluated, with an aim to developing guidelines for treatment. Physical, psychological, and metabolic side effects are associated with these agents. Of particular concern is the possible negation of estrogen's beneficial effect on the cardiovascular system after menopause. Continuous estrogen and progestogen administration is reputed to reduce the bleeding that occurs when the hormones are taken sequentially. Results from studies of continuous/combined therapy are presented in tabular form and evaluated. Effects on symptom control, bleeding, endometrial (uterine lining) histology, and lipids (fats) are discussed. Overall, the risks and side effects of adding progestogens to a regimen of estrogen replacement therapy must be considered carefully. The values of continuous/combined therapy have yet to be conclusively demonstrated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Dosage and administration, Estrogen, Estrogens, Progestational hormones

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Elevated serum testosterone, hirsutism, and virilism associated with combined androgen-estrogen hormone replacement therapy

Article Abstract:

Women often undergo treatment with a combination of the sex hormones androgen and estrogen for symptoms of menopause, decreased sex drive (libido), and premature menopause caused by surgery. The beneficial effects of such treatments have been studied, but little is known about any long-term side effects. This study reports side effects from long-term androgen-estrogen therapy in nine women who were being treated for menopausal symptoms. Signs of excessive levels of androgen were present in all nine patients. Eight of the nine women reported problems with excessive facial and bodily hair (hirsutism). Seven patients had clitoral enlargements related to high testosterone levels. Testosterone levels were higher in the patients that had received therapy for a longer time. Other symptoms reported included depression, decreased libido, and flushing. Therapy was discontinued in all patients. Testosterone levels decreased to normal levels within 12-20 months of discontinuation. These results indicate that androgen-estrogen combination replacement therapy can result in unwanted side effects. The normal dose of testosterone given is 10 times that normally produced. It is questionable whether this dosage is needed or useful. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Complications and side effects, Testosterone, Hypertrichosis

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