Long-acting agonists of LH-RH in the treatment of large ovarian endometriomas

Reversible temporary medical oophorectomy using long-acting agonist analogs of LH-RH was tried in three infertile patients suffering from large endometriomas of the ovary. These patients had stage IV disease according to the revised 1985 classification of the American Fertility Society. D-Ala⁶-des-Gly¹⁰-LH-RH propylamide (D-Ala⁶-LH-RH PA), in a dose of 125 μg, was administered intramuscularly every 48 hours to one patient, and daily to the other two patients, for 22, 17, and 14 weeks, respectively. Two patients subsequently received 100 μg of D-Trp^-LH-RH for 4 weeks in order to compare its efficacy with D-Ala⁶-LH-RH PA. Clinical controls, pelvic ultrasonography, and routine laboratory tests and hormone assays were done periodically. Ultrasonography images showed a reduction in the size of endometriomas after the second or third week of treatment. This reduction was maintained throughout and continued after the period of treatment. Suppression of the pituitary and estrogen responses was obtained rapidly, but some transient increments were occasionally found. Progesterone levels always decreased and remained in the range of the early follicular phase. Most intervals of uterine bleeding were prolonged. An evident improvement of abdominal pain, dysmenorrhea, and dyspareunia was found. Administration of D-Trp⁶-LH-RH was more effective than D-Ala⁶-LH-RH PA in most of the parameters tested. After discontinuation of treatment, all three patients had a prolonged follicular phase with a normal luteal phase during the first cycle. One woman became pregnant in the fourth cycle after discontinuation of D-Ala⁶-LH-RH PA and delivered a normal baby. A second patient, in whom the symptoms recurred, required additional treatment. After the discontinuation of analogs, the third patient remained asymptomatic and maintained reduction of ovarian size for more than 1 year. In view of improvement, verified clinically and by pelvic ultrasonography, and the rapid recovery of the ovalutory function, prolonged administration of superactive analogs of LH-RH should be considered for the treatment of endometriosis.