Sequential buserelin-medroxyprogesterone acetate treatment of leiomyomata uteri

The long-term pharmacological management of uterine leiomyomata necessitates a double strategy: first produce sufficient hypo-oestrogenism to reduce fibroid volume to an acceptable size and then supplementwith agents capable of maintaining this effect without the negative consequences of hypo-oestrogenism. Such a goal can conceivablybe achievedbye the use of a GnRH superagonist analogue followed, in a sequentialfashion, by the administration of a progestogen and/or of non -uterotropic oestrogen, either alone or in combination. Our group has initiated some 3 years ago a systematic study to evaluate the practicability of this approach utilizing a progestogen , medroxiprogesterone acetate (MPA), which by its biomchemical characteristics offered the best hope of success. Others have tested a regimen where, while continuing the analogue, MPA was added together with the commercially available combination of equine oestrogens known as Premarin (Chapter 13 and ref. 7). A variety of experimental and clinical data provide a rationale for the use of progestational steroids to maintain the rcgression in fibroid size obtained through hypo-oestrogenism rogenism Goldzichcr et have observed that progestogens in high doses have deleterious effects on leiomyomata, to the point of producing the so-called red degcneration, usually observed in pregnancy. In addition, progestogens can block oestrogen-induced uterine growth. Finally, analogugue therapy substantially decreases oestrogen receptors in fibroid tissue, while increasing progcstcrone receptors.