Long-term administration of tibolone plus gonadotropin-releasing hormone agonist for the treatment of uterine leiomyomas: effectiveness and effects on vasomotor symptoms, bone mass, and lipid profiles

Objective: To evaluate the effects of long-term administration of GnRH agon ist (GnRH-a) plus tibolone for uterine leiomyomatosis. Design: Prospective open clinical trial. Setting: Department of Gynecology, Obstetrics and Pathophysiology of Human Reproduction, University of Naples "Federico II", Naples, Italy. Patient(s): Twenty-five subjects with symptomatic uterine leiomyomas. Intervention(s): Treatment for 2 years with leuprolide acetate (3.75 mg IM every 25 days) and tibolone (2.5 mg/d per os). Main Outcome Measure(s): Uterine and uterine leiomyoma sizes, endometrial t hickness, lumbar spine bone mineral density (BMD), bone metabolism, lipid p rofile, myoma-related symptoms at baseline and every 6 months. Hot flashes and vaginal bleeding episodes recorded in a daily symptom diary. Result(s): After 6 months of treatment, a significant reduction was observe d in uterine and leiomyoma volumes and myoma-related symptoms compared with baseline values. No significant change was observed in bone turnover, lumb ar BMD, or serum total cholesterol, low-density lipoprotein cholesterol, or triglyceride levels. High-density lipoprotein cholesterol values were sign ificantly lower than baseline values after 6 months of treatment but not af ter 18 months of therapy. A low mean number of hot flashes per day was obse rved. Conclusion(s): Long-term administration of GnRH-a plus tibolone reduces hot flashes and prevents bone loss without changing the lipid profile. (Fertil Steril(R) 1999;72:889-95. (C)1999 by American Society for Reproductive Med icine.).