Oral Gonadotropin-Releasing Hormone Antagonists in the Treatment of Uterine Myomas: A Systematic Review and Network Meta-analysis of Efficacy Parameters and Adverse Effects.

OBJECTIVE: The aim of this systematic review is to gather and synthesize evidence regarding the use of oral gonadotrophin-releasing hormone (GnRH) antagonist for the treatment of bleeding associated with uterine myomas. DATA SOURCES: Web of Science, and MEDLINE databases were searched electronically on March 5, 2021, using combinations of the relevant Medical Subject Headings terms and keywords. The search was restricted to the English language and to human studies. METHODS OF STUDY SELECTION: Only randomized controlled trials involving patients with heavy menstrual bleeding associated with uterine myomas treated with different doses of oral nonpeptide GnRH antagonists with or without add-back therapy were included. Studies comparing oral nonpeptide GnRH antagonists with treatments other than placebo were also excluded. TABULATION, INTEGRATION, AND RESULTS: A total of 5 randomized trials including 2463 women were included in the analyses. Included studies were found to be at low risk of bias. When treatments were compared against placebo, the top 3 treatments for bleeding suppression were elagolix 600 mg, 400 mg, and 200 mg without add-back. Elagolix 600 mg without add-back therapy had a significantly higher risk of amenorrhea than lower doses of elagolix with and without add-back and relugolix as well. Uterine volume changes were more pronounced in therapies without add-back. All treatments were associated with significantly improved quality of life scores, both for myoma symptom-related and overall health-related scores. With the exception of relugolix with high-dose add-back, all treatments significantly increased low-density lipoprotein (LDL) levels. Again, all treatment modalities except for elagolix 200 mg without add-back significantly increased LDL-to-HDL ratio. The increase was highest for treatment without add-back therapy. CONCLUSION: Oral GnRH antagonists seem to be effective for myoma-associated bleeding and for improving quality of life. The safety profile is acceptable for short-term use, but lipid metabolism is affected.

Severe ovarian hyperstimulation syndrome and gonadotropin-releasing hormone agonist trigger in patients with hypogonadotropic hypogonadism: A report of two cases.

Ovarian Hyperstimulation syndrome (OHSS) is a rare condition in patients with hypogonadotropic hypogonadism. Two patients with hypogonadotropic hypogonadism are reported, a rare case of severe OHSS and a case of prevented OHSS via gonadotropin-releasing hormone (GnRH) agonist trigger, respectively. The first case was a 31-year-old patient. In vitro fertilization (IVF) treatment was performed three times but the patient never developed OHSS. The first patient was diagnosed as having severe OHSS on the ninth day after the fresh embryo transfer. She stayed 66 days in hospital and 50.5 litres of fluid were aspirated from her abdomen. The second case was a 26-year-old and primary infertile patient. She had never undergone IVF treatment. The GnRH agonist stimulation test was performed before IVF treatment. After the ovarian stimulation, GnRH agonist trigger was given. Thirty-two oocytes were retrieved from the ovaries and OHSS did not occur. Although severe OHSS is rare, it can develop in patients hypogonadotropic hypogonadism. If a GnRH stimulation test is performed before ovarian stimulation, OHSS can be prevented because the test allows agonist triggering instead of hCG in hypogonadotropic hypogonadism.