[Surveillance of hormone replacement therapy]. / Surveillance de l'hormonothérapie substitutive.

The prescription of hormone replacement therapy (HRT) requires a pretherapeutic evaluation and an ongoing surveillance during treatment. Pretherapeutic evaluation identifies the indications and contraindications to HRT. It includes a clinical examination, a Papanicolaou smear, and other tests according to the clinical situation. Monitoring of HRT consists of a first follow-up visit 3 months after beginning treatment to assess the effectiveness, side effects, and compliance with the therapy. Following this, yearly medical examinations should be scheduled. This paper describes the most frequent clinical signs that suggest a modification of treatment or the need to perform further investigations.

[Treatment of endometriosis with the GnRH agonist leuprorelin acetate depot (Enatone-Gyn monthly depot): a multicenter study]. / Behandlung der Endometriose mit dem GnRH-Agonisten Leuprorelinacetat Depot (Enatone-Gyn Monats-Depot): Eine multizentrische Studie.

In an open, non-randomized prospective phase-III-study the clinical and endocrine efficacy as well as the safety of leuprorelin acetate depot (Enantone-Gyn Monats-Depot) were investigated. The therapeutic results of 198 patients, gathered from 5 university institutions and two city hospitals, are reported. Endometriosis was classified by the revised American Fertility Society score (r-AFS) before and at the end of treatment. Serum levels of LH, FSH, prolactin, estradiol, progesterone, androstenedione, testosterone and leuprorelin acetate were determined by radioimmunoassay. The mean total r-AFS score changed as follows: before surgical intervention during first-look laparoscopy 21 +/- 24 at the end of first-look laparoscopy 15 +/- 19 at the end of the GnRH-treatment 8 +/- 14 During leuprorelin acetate treatment the r-AFS stages changed as follows: [table; see text] Using the scoring system 85.2% of the patients improved. Relief of dysmenorrhoea could be achieved in 95.4%, relief of dyspareunia in 64% and of pelvic pain in 69.4% of patients. Baseline hormone levels dropped sharply during treatment. [table; see text] Androstenedione, testosterone, blood pressure, body weight, haematological parameters, liver enzymes, creatinine, electrolytes and HDL-/LDL-cholesterin remained more or less unchanged. Side effects being hot flushes, sweating, sleeplessness, headache, nausea, depression and vaginal dryness were due to estradiol deprivation. In 135 patients resumption of menstruation occurred in 95.6% within the first three months post-treatment. 23 patients of whom 21 were judged as infertile, became pregnant immediately after treatment was finished. The study results confirm the efficacy of leuprorelin acetate depot in the treatment of even advanced stages of endometriosis.

Contraceptive properties of luteinising hormone releasing hormone.

PIP: The report of Dr Bergquist and colleagues (Aug. 4, p. 215) on the contraceptive effect of an intranasally administered analogue of luteinising hormone releasing hormone (LHRH) holds out the promise of a new approach to contraception that is safer than oral contraception or intrauterine devices. we have studied the endocrine effects of the natural peptide when administered subcutaneously in a dose of 100 mg daily to four normally ovulation women. Measurements on blood-samples taken daily during complete control and treatment cycles revealed a blunting of the LH peaks associated with lowered oestradiol concentrations and absence of the post-follicular progesterone rise. These findings stimualted us to undertake a study of the contraceptive properties of LHRH given as a nasal spray. Sixteen women volunteers, all with normal ovulatory cycles and normal responses to intravenous LHRH before treatment started, took 2 mg LHRH twice daily by the nasal route. Ovulation seemed to be inhibited, as indicated by hormone measurements throughout the latter half of the cycle. No woman showed ovulatory progesterone concentrations, although all menstruated. No side-effects were noted. This study will be continued in individual women for 3-6 months, at which time treatment will be interrupted to assess the time of recurrence of ovulation.^ieng

[Comparative biochemical investigations with contraceptives at different dose levels (author's transl)]. / Vergleichende biochemische Untersuchungen mit verschieden dosierten Kontrazeptiva.

In adolescent girls the administration of hormonal contraception raises special problems because of the still unstable menstrual cycle of this group. The influence of four oral contraceptives with different high doses on the levels of the two gonadotropins, estradiol and progesterone has been studied with the aid of the GnRH-test before, during and after treatment. According to the results obtained low-dose combination preparations should be administered to adolescents with stable cycles as in this group normal physiological conditions reappeared without delay after discontinuation of a one-year treatment. If the cycle pattern is still irregular a low-dose gestagen ("minipill") preparation may be chosen. This type of treatment showed the least central inhibition, probably advantageous with regard to the still immature cycle.

PIP: Gonadotropin-releasing hormone (GnRH) was administered to 141 women, 15-22 years of age, who were using various oral contraceptive (o.c.) preparations. LH, FSH, Progesterone, and estradiol levels, as well as LH and FSH stimulation rates, were measured before and after o.c. use. The women were divided into 4 groups: I: 50 mcg ethinyl estradiol (EE) and 1 mg lynestrol (L); II: 50 mcg EE and .75 mg L; III: 37.5 mcg EE and .75 mg L; IV: .5 mg L. In group I, all values were significantly lowered, and there was a significant decrease in LH and FSH stimulation rates (p ? .001). In group II, the same results were obtained, except that the pre-GmRH levels approached values observed before o.c. use with increased length of o.c. use. In group III, all values tended to return to the pre-o.c. levels as the o.c. use progressed. In group IV, only progesterone levels and LH stimulation rates were significantly reduced. Low-dosage combination preparations should be administered to adolescents with stable cycles, and mini-pills to those who haven't established regular cycles.