EFFECT OF INSUFLATED NAFARELIN (D-NAL-6-GNRH) UPON UTERINE LEIOMYOMATA

A nasal spray containing the GnRH analog Nafarelin (D-Nal-6-GnRH) was used to treat 20 patients of reproductive age with clinical and ultras onographic diagnosis of uterine leiomyomata. Nafarelin showed a high i ndex of efficacy (similar to 65%) in decreasing the volume of myomas, The collateral effects observed were scarce; among these were predomin ant a decrease of libido and vasomotor symptoms. Although bone pain wa s not referred, the impact upon osteodensity was not assessed. The eff ect upon pituitary gonadotropin production as well as that of sexual s teroids by GnRH was practically null, and one patient became pregnant. Nonetheless, those symptoms associated with the use of Nafarelin were apparently due to a moderate hypoestrogenism, despite not being subst antiated in the laboratory studies, With such disparity, we assume it was given by the route of administration of nasal Nafarelin, which is known to have erratic effects due to limitations in its absorption. Th us, far from being a disadvantage it could be useful in regimes of lon g term therapy (1-2 years) to avoid the impact of estrogen shortage up on bone turnover. We conclude that Nafarelin through insuflation was h ighly effective for decreasing the size of uterine leiomyomata.