GnRH agonists are now used in gynecologic practice in all clinical conditions requiring inhibition of pituitary-gonadal axis. Treatment with I.N. buserelin has been demonstrated effective in the management of these various conditions, despite the different degree of pituitary-ovarian suppression theoretically required to obtain the optimal therapeutic effect, since by modulating the dosage and frequency of administration of the drug it is possible to achieve different degree of suppression. In conditions like breast cancer, in which a rapid and sustained inhibition of ovarian activity is expected, I.N. formulation would not seem the most suitable. On the contrary, the I.N. formulation is the only feasible one for contraception since in this case adequate estrogen levels should be maintained to avoid the effects of hypoestrogenism on bone and to allow an artificial cycle with the addition of a progestogen. In the treatment of endometriosis and uterine leimyomas I.N. buserelin has been found as effective as subcutaneous treatment and with less severe side effects. Furthermore, there is no clinical difference between the two administration modalities in reproductive success after stimulation of ovulation with gonadotropins for which theoretically complete pituitary-gonadal suppression is required. Unless it is shown that the above clinical conditions require a complete medical castration, I.N. buserelin will probably become the medical therapeutic modality of choice in the near future. A real step forward in the treatment with GnRH agonists will be made when their pharmacologic characteristics and mechanism of action are better understood.
|Title of host publication||Advances in Contraceptive Delivery Systems|
|Number of pages||28|
|Publication status||Published - 1989|
ASJC Scopus subject areas
- Obstetrics and Gynaecology