Efficacy and safety considerations in women with uterine leiomyomas treated with gonadotropin-releasing hormone agonists: The estrogen threshold hypothesis

Gonadotropin-releasing hormone agonists induce a reversible hypogonadotropic hypogonadal environment. Leiomyomas are common, estrogen-sensitive, benign neoplasms that decrease in size by 40% to 50% during gonadotropin-releasing hormone agonist treatment. During gonadotropin-releasing hormone agonist...

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Veröffentlicht in:American journal of obstetrics and gynecology 1990-10, Vol.163 (4), p.1114-1119
Hauptverfasser: Friedman, Andrew J., Lobel, Susan M., Rein, Mitchell S., Barbieri, Robert L.
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container_end_page 1119
container_issue 4
container_start_page 1114
container_title American journal of obstetrics and gynecology
container_volume 163
creator Friedman, Andrew J.
Lobel, Susan M.
Rein, Mitchell S.
Barbieri, Robert L.
description Gonadotropin-releasing hormone agonists induce a reversible hypogonadotropic hypogonadal environment. Leiomyomas are common, estrogen-sensitive, benign neoplasms that decrease in size by 40% to 50% during gonadotropin-releasing hormone agonist treatment. During gonadotropin-releasing hormone agonist therapy most women are amenorrheic. After discontinuation of gonadotropin-releasing hormone agonist treatment, uterine and myoma size increase and a return to pretreatment menstrual patterns often occurs. Concerns about the safety of long-term hypoestrogenism have made long-term gonadotropin-releasing hormone agonist administration an undesirable treatment strategy. This article focuses on the use of gonadotropin-releasing hormone agonists as preoperative therapy in selected women undergoing hysterectomy or myomectomy and the combination of a gonadotropin-releasing hormone agonist with estrogen-progestin "add-back" treatment as a potential long-term medical therapy for women with symptomatic leiomyomas. Finally, an estrogen threshold hypothesis to assess the effects of circulating estrogen concentrations on different tissues, is presented. (Am J Obstet Gynecol 1990;163: 1114-9.)
doi_str_mv 10.1016/0002-9378(90)90667-V
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Leiomyomas are common, estrogen-sensitive, benign neoplasms that decrease in size by 40% to 50% during gonadotropin-releasing hormone agonist treatment. During gonadotropin-releasing hormone agonist therapy most women are amenorrheic. After discontinuation of gonadotropin-releasing hormone agonist treatment, uterine and myoma size increase and a return to pretreatment menstrual patterns often occurs. Concerns about the safety of long-term hypoestrogenism have made long-term gonadotropin-releasing hormone agonist administration an undesirable treatment strategy. This article focuses on the use of gonadotropin-releasing hormone agonists as preoperative therapy in selected women undergoing hysterectomy or myomectomy and the combination of a gonadotropin-releasing hormone agonist with estrogen-progestin "add-back" treatment as a potential long-term medical therapy for women with symptomatic leiomyomas. Finally, an estrogen threshold hypothesis to assess the effects of circulating estrogen concentrations on different tissues, is presented. (Am J Obstet Gynecol 1990;163: 1114-9.)</description><subject>Biological and medical sciences</subject><subject>Buserelin - administration &amp; dosage</subject><subject>Buserelin - analogs &amp; derivatives</subject><subject>Buserelin - therapeutic use</subject><subject>Estradiol - blood</subject><subject>estrogen threshold hypothesis</subject><subject>Estrogens - blood</subject><subject>Estrogens - therapeutic use</subject><subject>Female</subject><subject>GnRH agonist</subject><subject>Gonadotropin-Releasing Hormone - administration &amp; dosage</subject><subject>Gonadotropin-Releasing Hormone - analogs &amp; derivatives</subject><subject>Gonadotropin-Releasing Hormone - therapeutic use</subject><subject>Goserelin</subject><subject>Hormones. Endocrine system</subject><subject>Humans</subject><subject>hysterectomy</subject><subject>Leiomyoma - drug therapy</subject><subject>Leiomyoma - pathology</subject><subject>Leiomyoma - surgery</subject><subject>Leuprolide</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>myomectomy</subject><subject>Pharmacology. Drug treatments</subject><subject>Pilot Projects</subject><subject>Preoperative Care</subject><subject>Progestins - therapeutic use</subject><subject>Time Factors</subject><subject>uterine leiomyomas</subject><subject>Uterine Neoplasms - drug therapy</subject><subject>Uterine Neoplasms - pathology</subject><subject>Uterine Neoplasms - surgery</subject><subject>Uterus - pathology</subject><issn>0002-9378</issn><issn>1097-6868</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1990</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UU1v1DAUtBCobAv_ACQfEIJDwM7GTswBCVUtIFXiUnq1HPtlY5TYi58XlN_Cn8VhV3vk4g_NvHmjGUJecPaOMy7fM8bqSm3b7o1ibxWTsq0eHpENZ6qtZCe7x2Rzpjwll4g_1m-t6gtyUfNGtFJsyJ-bYfDW2IWa4CiaAfJCbQzoHSSTfXlRH-jvOEM5fR7pIUPyAegEPs5LnA3SnMBkcEd8F4NxMae496FKMIFBH3Z0jGmOZcwU3GPGD_R-BApYiLsinccEOMbJ0XHZxzwCenxGngxmQnh-uq_I99ub--sv1d23z1-vP91VtuE8V62rFVc9b7hgRgIXshei7bkUEpjqhq5RrXDbtm4EuGZwvVGisYq3Be_rVm6vyOuj7j7Fn4diSc8eLUyTCRAPqDvGZFOzrhCbI9GmiJhg0PvkZ5MWzZleO9FrwnoNXCum_3WiH8rYy5P-oZ_BnYdOJRT81Qk3aM00JBOsxzNNCFXWrzY_HmlQsvjlIWm0HoIF5xPYrF30__fxF1skrAk</recordid><startdate>19901001</startdate><enddate>19901001</enddate><creator>Friedman, Andrew J.</creator><creator>Lobel, Susan M.</creator><creator>Rein, Mitchell S.</creator><creator>Barbieri, Robert L.</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19901001</creationdate><title>Efficacy and safety considerations in women with uterine leiomyomas treated with gonadotropin-releasing hormone agonists: The estrogen threshold hypothesis</title><author>Friedman, Andrew J. ; Lobel, Susan M. ; Rein, Mitchell S. ; Barbieri, Robert L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c411t-7d2919b14150a6e156b557b1656e098f84975d37245ed4fdba954c91756eb2763</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1990</creationdate><topic>Biological and medical sciences</topic><topic>Buserelin - administration &amp; dosage</topic><topic>Buserelin - analogs &amp; derivatives</topic><topic>Buserelin - therapeutic use</topic><topic>Estradiol - blood</topic><topic>estrogen threshold hypothesis</topic><topic>Estrogens - blood</topic><topic>Estrogens - therapeutic use</topic><topic>Female</topic><topic>GnRH agonist</topic><topic>Gonadotropin-Releasing Hormone - administration &amp; dosage</topic><topic>Gonadotropin-Releasing Hormone - analogs &amp; derivatives</topic><topic>Gonadotropin-Releasing Hormone - therapeutic use</topic><topic>Goserelin</topic><topic>Hormones. Endocrine system</topic><topic>Humans</topic><topic>hysterectomy</topic><topic>Leiomyoma - drug therapy</topic><topic>Leiomyoma - pathology</topic><topic>Leiomyoma - surgery</topic><topic>Leuprolide</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>myomectomy</topic><topic>Pharmacology. Drug treatments</topic><topic>Pilot Projects</topic><topic>Preoperative Care</topic><topic>Progestins - therapeutic use</topic><topic>Time Factors</topic><topic>uterine leiomyomas</topic><topic>Uterine Neoplasms - drug therapy</topic><topic>Uterine Neoplasms - pathology</topic><topic>Uterine Neoplasms - surgery</topic><topic>Uterus - pathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Friedman, Andrew J.</creatorcontrib><creatorcontrib>Lobel, Susan M.</creatorcontrib><creatorcontrib>Rein, Mitchell S.</creatorcontrib><creatorcontrib>Barbieri, Robert L.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of obstetrics and gynecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Friedman, Andrew J.</au><au>Lobel, Susan M.</au><au>Rein, Mitchell S.</au><au>Barbieri, Robert L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Efficacy and safety considerations in women with uterine leiomyomas treated with gonadotropin-releasing hormone agonists: The estrogen threshold hypothesis</atitle><jtitle>American journal of obstetrics and gynecology</jtitle><addtitle>Am J Obstet Gynecol</addtitle><date>1990-10-01</date><risdate>1990</risdate><volume>163</volume><issue>4</issue><spage>1114</spage><epage>1119</epage><pages>1114-1119</pages><issn>0002-9378</issn><eissn>1097-6868</eissn><coden>AJOGAH</coden><abstract>Gonadotropin-releasing hormone agonists induce a reversible hypogonadotropic hypogonadal environment. Leiomyomas are common, estrogen-sensitive, benign neoplasms that decrease in size by 40% to 50% during gonadotropin-releasing hormone agonist treatment. During gonadotropin-releasing hormone agonist therapy most women are amenorrheic. After discontinuation of gonadotropin-releasing hormone agonist treatment, uterine and myoma size increase and a return to pretreatment menstrual patterns often occurs. Concerns about the safety of long-term hypoestrogenism have made long-term gonadotropin-releasing hormone agonist administration an undesirable treatment strategy. This article focuses on the use of gonadotropin-releasing hormone agonists as preoperative therapy in selected women undergoing hysterectomy or myomectomy and the combination of a gonadotropin-releasing hormone agonist with estrogen-progestin "add-back" treatment as a potential long-term medical therapy for women with symptomatic leiomyomas. 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subjects Biological and medical sciences
Buserelin - administration & dosage
Buserelin - analogs & derivatives
Buserelin - therapeutic use
Estradiol - blood
estrogen threshold hypothesis
Estrogens - blood
Estrogens - therapeutic use
Female
GnRH agonist
Gonadotropin-Releasing Hormone - administration & dosage
Gonadotropin-Releasing Hormone - analogs & derivatives
Gonadotropin-Releasing Hormone - therapeutic use
Goserelin
Hormones. Endocrine system
Humans
hysterectomy
Leiomyoma - drug therapy
Leiomyoma - pathology
Leiomyoma - surgery
Leuprolide
Medical sciences
Middle Aged
myomectomy
Pharmacology. Drug treatments
Pilot Projects
Preoperative Care
Progestins - therapeutic use
Time Factors
uterine leiomyomas
Uterine Neoplasms - drug therapy
Uterine Neoplasms - pathology
Uterine Neoplasms - surgery
Uterus - pathology
title Efficacy and safety considerations in women with uterine leiomyomas treated with gonadotropin-releasing hormone agonists: The estrogen threshold hypothesis
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