Two-step gonadotropin-releasing hormone agonist treatment of uterine leiomyomas: Standard-dose therapy followed by reduced-dose therapy

OBJECTIVE: Gonadotropin-releasing hormone agonist-induced partial pituitary 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 triptorelin for 8 weeks. Patients were then randomized to use 100, 20, or 5 μg of triptorelin until week 26. Uterine and myoma size, pituitary-ovarian function, bone metabolism, and bone mineral density were monitored. RESULTS: During standard treatment uterine size was reduced to 67.1% of baseline. During randomized treatment uterine size was further reduced to 57.8% of baseline. There were no differences in overall volume reduction among the groups. Luteinizing hormone and estradiol levels were restored in a dose- dependent way. Bone mineral density decreased significantly in the highest- dose group at week 26. CONCLUSIONS: This study shows that the beneficial effects of initial high-dose agonist treatment on uterine leiomyomas can be preserved by continued low-dose treatment. Bone mineral density does not seem to change during reduced-dose agonist treatment.