[Clinical application of luteinizing hormone releasing hormone agonist and its impact on bone metabolism]

OBJECTIVES: To evaluate the efficacy of luteinizing hormone releasing hormone agonist (LHRH-A) in the treatment of endometriosis (Em), uterine leiomyoma and adenomyosis, and its impact on bone metabolism. METHODS: Twenty patients, Em 13 (stage II4, III7, IV2), leiomyoma 4 and adenomyosis 3, were selected to receive LHRH-A 200 micrograms intramuscular daily for 3 months. Clinical and ultrasound features serum follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), osteocalcin (BGP) concentrations were compared before and at the end of treatment. Furthermore, 24-hour urinary calcium (Ca), phosphate (P) excretions and bone mineral density (BMD) of radius and lumbar spine measured by single photon absorptiometry (SPA) and dual energy X-ray absorptiometry (DEXA) were also analysed before and at the end of treatment. Patients were followed-up 3-19 months after discontinuation of the drug. RESULTS: At the end of treatment dysmenorrhea disappeared in all 15 cases. Pelvic tenderness and induration improved in 18, endometrioma shrinked in 13 cases. Mean uterine volume of 7 patients with leiomyoma or adenomyosis was reduced by 35% from the basal volume. Serum LH, E2 levels were suppressed significantly (P < 0.05), mean E2 concentration declined from 459.5 +/- 292.0 to 160.3 +/- 110.7 pmol/L (P < 0.001). No significant change was found in serum BGP, urinary Ca, P, and BMD of radius and lumbar spine at the end of therapy, The only side effect was mild not flushes and sweating during treatment. After stopping the drug, 17 patients resumed menses within 2 months. Dysmenorrhea and pelvic mass recurred in 6 months with less severity. One became pregnant in 3 months. CONCLUSIONS: LHRH-A administration is effective in the treatment of Em, leiomyoma and adenomyosis. No significant adverse effect was shown on bone metabolism at the end of 3-month therapy.