The Usefulness of Medroxy-Progesterone Acetate for Genital Spotting after the First Injection of GnRH Agonist Treatment for Endometriosis
Keywords:
Endometriosis, Gonadotropin-releasing hormone agonist, Medroxy-progesterone acetate, Genital spotting.Abstract
The best treatment for endometriosis remains gonadotropin-releasing hormone (GnRH) agonist. However, most patients complain of genital spotting during the first month after the injection of GnRH agonist, a distressful side effect of treatment with GnRH agonist for endometriosis. Therefore, we investigated the effect of 10mg daily medroxy-progesterone acetate (MPA) for seven (group 1) or 14 days (group 2) for genital spotting.
We observed the discontinuation of genital spotting and compared the days from medication administration to the discontinuation of genital spotting between the two groups.
(1) In all patients, genital spotting stopped 5-7 days after MPA treatment (p < 0.01).
(2) There was no statistically significant difference in the number of days until discontinuation of genital spotting after 10 mg MPA treatment between the two groups (p = nonspecific).
(3) There was no recurrence of genital spotting in either group during six months of GnRH agonist treatment.
Therefore, genital spotting during the first month following the injection of GnRH agonist was effectively managed with seven days of 10mg/day MPA. This proved to be a very useful treatment method for genital spotting during the first month after the injection of GnRH agonist.
References
Winkel CA. Evaluation and management of women with endometriosis. Obstetrics and gynecology. 2003 Aug; 102(2): 397-408. https://doi.org/10.1097/00006250-200308000-00032
Winkel CA, Scialli AR. Medical and surgical therapies for pain associated with endometriosis. Journal of women's health & gender-based medicine. 2001 Mar; 10(2): 137-62. https://doi.org/10.1089/152460901300039485
Takayama K, Zeitoun K, Gunby RT, Sasano H, Carr BR, Bulun SE. Treatment of severe postmenopausal endometriosis with an aromatase inhibitor. Fertility and sterility. 1998 Apr; 69(4): 709-13. https://doi.org/10.1016/S0015-0282(98)00022-3
Ailawadi RK, Jobanputra S, Kataria M, Gurates B, Bulun SE. Treatment of endometriosis and chronic pelvic pain with letrozole and norethindrone acetate: a pilot study. Fertility and sterility. 2004 Feb; 81(2): 290-6. https://doi.org/10.1016/j.fertnstert.2003.09.029
Luciano AA, Turksoy RN, Carleo J. Evaluation of oral medroxyprogesterone acetate in the treatment of endometriosis. Obstetrics and gynecology. 1988 Sep; 72(3 Pt 1): 323-7.
Harada T, Taniguchi F. Dienogest: a new therapeutic agent for the treatment of endometriosis. Women's health (London, England). 2010 Jan; 6(1): 27-35. https://doi.org/10.2217/WHE.09.72
Kohler G, Goretzlehner G, Amon I. [Therapy of endometriosis with dienogest]. Zentralblatt fur Gynakologie. 1987; 109(12): 795-801.
McCormack PL. Dienogest: a review of its use in the treatment of endometriosis. Drugs. 2010 Nov 12; 70(16): 2073-88. https://doi.org/10.2165/11206320-000000000-00000
Lemay A, Quesnel G. Potential new treatment of endometriosis: reversible inhibition of pituitary-ovarian function by chronic intranasal administration of a luteinizing hormone-releasing hormone (LH-RH) agonist. Fertility and sterility. 1982 Sep; 38(3): 376-9. https://doi.org/10.1016/S0015-0282(16)46522-2
Conn PM, Crowley WF, Jr. Gonadotropin-releasing hormone and its analogues. The New England journal of medicine. 1991 Jan 10; 324(2): 93-103. https://doi.org/10.1056/NEJM199101103240205
Dawood MY. Impact of medical treatment of endometriosis on bone mass. American journal of obstetrics and gynecology. 1993 Feb; 168(2): 674-84. https://doi.org/10.1016/0002-9378(93)90516-L
Tummon IS, Ali A, Pepping ME, Radwanska E, Binor Z, Dmowski WP. Bone mineral density in women with endometriosis before and during ovarian suppression with gonadotropin-releasing hormone agonists or danazol. Fertility and sterility. 1988 May; 49(5): 792-6. https://doi.org/10.1016/S0015-0282(16)59885-9
Henzl MR, Corson SL, Moghissi K, Buttram VC, Berqvist C, Jacobson J. Administration of nasal nafarelin as compared with oral danazol for endometriosis. A multicenter doubleblind comparative clinical trial. The New England journal of medicine. 1988 Feb 25; 318(8): 485-9. https://doi.org/10.1056/NEJM198802253180805
Miller RM, Frank RA. Zoladex (goserelin) in the treatment of benign gynaecological disorders: an overview of safety and efficacy. British journal of obstetrics and gynaecology. 1992 Feb; 99 Suppl 7: 37-41. https://doi.org/10.1111/j.1471-0528.1992.tb13539.x
Nafarelin for endometriosis: a large-scale, danazol-controlled trial of efficacy and safety, with 1-year follow-up. The Nafarelin European Endometriosis Trial Group (NEET). Fertility and sterility. 1992 Mar; 57(3): 514-22. https://doi.org/10.1016/S0015-0282(16)54893-6
Hughes EG, Fedorkow DM, Collins JA. A quantitative overview of controlled trials in endometriosis-associated infertility. Fertility and sterility. 1993 May; 59(5): 963-70. https://doi.org/10.1016/S0015-0282(16)55911-1
