2-STEP GONADOTROPIN-RELEASING-HORMONE AGONIST TREATMENT OF UTERINE LEIOMYOMAS - STANDARD-DOSE THERAPY FOLLOWED BY REDUCED-DOSE THERAPY

OBJECTIVE: Gonadotropin-releasing hormone agonist-induced partial pitu itary suppression with low-grade estrogen production may be useful in long-term treatment of uterine leiomyomas. STUDY DESIGN: Twenty-seven women with uterine leiomyomas were treated with a standard dose of tri ptorelin for 8 weeks. Patients were then randomized to use 100, 20, or 5 mu g of triptorelin until week 26. Uterine and myoma size, pituitar y-ovarian function, bone metabolism, and bone mineral density were mon itored. RESULTS: During standard treatment uterine size was reduced to 67.1% of baseline. During randomized treatment uterine size was furth er reduced to 57.8% of baseline. There were no differences in overall volume reduction among the groups. Luteinizing hormone and estradiol l evels were restored in a dose-dependent way. Bone mineral density decr eased significantly in the highest-dose group at week 26. CONCLUSIONS: This study shows that the beneficial effects of initial high-dose ago nist treatment on uterine leiomyomas can be preserved by continued low -dose treatment. Bone mineral density does not seem to change during r educed-dose agonist treatment.