Long-term Follow-up of Premenopausal Women with Uterine Leiomyomas Treated with Administration of Gonadotropin-releasing Hormone Agonist

Abstract

Seventy-three women with uterine leiomyoma, who did not want to undergo surgery, received four months of administration of gonadotropin-releasing hormone agonist (GnRHa) which was repeated at intervals of 4-6 months. Forty-two women resumed their menstruation after discontinuation of GnRHa (non-menopause group), whereas 31 women reached menopause after GnRHa, avoiding surgery for leiomyomas (menopause group) successfully. In non-menopause group, the serum concentrations of LH, FSH, estradiol (E_2) and uterine volume decreased significantly during GnRHa therapy and returned to pretreatment values 4 months after cessation of therapy. In menopause group, these parameters decreased during GnRHa therapy similarly to non-menopause group. After cessation of therapy, however, the serum concentrations of LH and FSH increased up to significantly higher values than pretreatment ones, the serum concentrations of E_2 remained in the castrate range, and their uteri maintained reduced volumes. The pretreatment values of LH and FSH in serum were significantly higher in menopause group than in non-menopause group. Long-term follow-up after GnRHa therapy revealed that it took 16.3 ±9.7 months to reach menopause following occasional metrorrhagia and that a transient decrease in serum LH and FSH levels with a transient increase in serum E_2 levels caused an increase in uterine volume and metrorrhagia. Bone mineral density (BMD) decreased during GnRHa therapy and returned to pretreatment levels 6 to 10 months after cessation of therapy. Long-term follow-up after menopause showed a similar decrease in BMD with increasing age to that in normal women.