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During the past decade, the development of various gonadotrophin-releasing hormone (Gn-RH) agonists, which induce reversible hypo-oestrogenism has opened a new area in the medical management of endometriosis. In an open, multicentre phase III study, the efficacy, tolerance and safety of the Gn-RH agonist leuprorelin acetate were tested. The preliminary results of 104 women treated in seven German centres are presented. Pelvic endometriosis was diagnosed by laparoscopy and classified according to the American Fertility Society scoring system: 33% of patients had minimal, 22% mild, 28% moderate and 8% severe endometriosis and in 9% no pathological results were obtained. The patients' mean age was 30 +/- 6 years and 66 had infertility problems. Treatment was started within the first 3 days of the menstrual cycle and consisted of a subcutaneous injection of leuprorelin acetate 3.75 mg, repeated once monthly over 24 weeks. A follow-up period of 12 months after the last injection has been completed in 70 patients, including a second laparoscopy. At all visits, symptoms were evaluated, physical examinations performed, and blood samples collected for haematological screening, serum chemistry determinations and measurement of the gonadotrophins oestradiol and progesterone and leuprorelin acetate. The median score at laparoscopy fell from 12 before operation to 8 after operation and 2 after treatment with leuprorelin acetate. Of the total number of patients, 89% had improvements in their endometriosis, 8% a deterioration and 3% no change. Patients reported improvement in the following: dysmenorrhoea 93%, dyspareunia 62% and pelvic pain 70%. However, all women complained of at least one of the following symptoms: hot flushes 86%, sleep disturbance 62%, sweating 61%, headache 41%, nausea 32% and depression 20%. Fifty-five percent of patients reported additional side effects such as vaginal dryness, fatigue and lower abdominal pain. After the third injection, amenorrhoea persisted in 94% of the women. Four weeks after the first leuprorelin acetate injection median concentrations of oestradiol fell from 45 pg/ml to 11 pg/ml, follicle-stimulating hormone from 7 U/L to 3 U/L and luteinising hormone from 5 U/L to 1 U/L and remained almost unchanged over the observation period. During the 6 months' treatment, laboratory parameters showed no significant deviations from normal; only total cholesterol, high-density lipoprotein cholesterol and alkaline phosphatase increased. Treatment results were judged as good and satisfactory in 82% and 11% of cases, respectively. On the basis of this study, it can be concluded that leuprorelin acetate treatment is safe, well tolerated and effective in the medical management of endometriosis and endometriosis-related complaints.
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PMID:Treatment of endometriosis with leuprorelin acetate depot: a German multicentre study. 153 21

The forms of administration, mechanisms of action, side effects and complications, and other aspects of female hormonal contraception are set forth in this "lesson" for medical students. Female hormonal contraception has been in use for over 30 years and is used by more than 150 million women worldwide. Oral contraceptives suppress the preovulatory peak of follicle stimulating hormone and luteinizing hormone, preventing ovulation and follicular maturation. Progestins render the cervical mucus impermeable to sperm and modify the endometrium so that it will no longer support implantation. The synthetic estrogen ethinyl estradiol is used in most combined oral contraceptives (OCs). Among the numerous progestins in use are the newer desogestrel, gestodene, and norgestimate, which have fewer androgenic and metabolic effects than did the 1st generation. the different forms of administration of hormonal methods include combined OCs, oral preparations containing low doses of progestin continuously administered or high doses continuously or discontinuously administered. Intramuscular injection of progestins and the so-called "morning after" postcoital pills are less often prescribed. The combined preparations may be monophasic, biphasic, triphasic, or sequential. Sequential preparations should be avoided because of the hyperestrogenic climate they induce. The low-dose progestin preparations are indicated for women with contraindications to synthetic estrogen. They must be taken at the same time each day and have a relatively high rate of side effects, especially ovarian and breast cysts and irregular bleeding. High-dose progestin preparations have significant metabolic effects and are indicated primarily for patients with gynecological problems such as fibromas and endometriosis. Intramuscular injection of medroxyprogesterone acetate every 3 months is effective but has the same side effects as high-dose progestins. It is indicated primarily for patients unable to control their own behavior. The hormonal methods are all highly effective in preventing pregnancy when correctly administered. Side effects may be minor problems, such as nervousness and nausea, that are usually of short duration. the more serious side effects, including modifications of lipid or carbohydrate metabolism, hemostasis, blood pressure, or hepatic functioning and cardiovascular effects, have been reduced with the new lower dosed formulations. Absolute contraindications to hormonal contraception include undiagnosed vaginal bleeding or amenorrhea, history of thromboembolic or cerebral vascular accidents, severe cardiopathy or hypertension, hyperlipidemia, hepatopathy, hormonodependent cancer, pituitary tumors, porphyria, and severe mental problems. Relative contraindications impose the need for careful monitoring and follow-up. The practitioner should be aware of the possibility of interactions between OCs and certain other drugs.
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PMID:[Hormonal contraception]. 160 74

60,000 women in France have received RU 486 and a prostaglandin to induce abortion. In the late 1980's, clinical researchers assessed the safety and effectiveness of 600 mg of oral RU 486 in 2040 French women. 2 days later, health workers either injected 0.25-0.5mg of sulprostone or inserted a 1mg vaginal suppository of gemeprost in 1964 women who had not yet aborted. 96% experienced complete abortions. Physicians needed to conduct either a vacuum aspiration of dilation and curettage on the other 4%. RU 486 was most successful with 0.5mg of sulprostone, but these women also experienced considerable vaginal bleeding and pain. Overall uterine bleeding occurred for 8.9 days. The researchers recommended that adequate medical facilities be accessible to women using this method. Mild side effects were nausea, vomiting, and diarrhea. Efficacy and safety matched those of other early abortion methods. In April 1991, a grand multiparous women who smoked heavily and received RU 486 and a prostaglandin died--the 1st reported RU 486 related death. RU 486 may be able to treat fibroids, endometriosis, premenstrual syndrome, meningioma, hypertension, adrenal cancer, glaucoma, some forms of Cushing's syndrome, and breast cancer. The US Food and Drug Administration forbade the commercial import of RU 486 in 1989, even though it deemed RU 486 safe and effective. FDA considered the antiabortion view of the Bush Administration when making this decision. It made this decision despite the fact that abortion was still legal. RU 486 should be available soon for use as an abortifacient in the UK, the Netherlands, Sweden, Norway, Denmark, and Finland. These countries do not intent providing it to US women, however. Further the manufacturer is not willing to provide it to US researchers because it is afraid of antiabortion repercussions which may jeopardize WHO's approval of RU 486.
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PMID:The RU 486 story: the French experience. 173 8

The efficacy and safety of buserelin acetate in the treatment of endometriosis was studied in 4 open non-comparative trials and 2 open randomized comparative trials with danazol. 444 women were enrolled in the buserelin group and 89 in the danazol group. Treatment was for 6-10 months using 900-1200/micrograms intranasal buserelin/day and 400-800/micrograms oral danazol/day; patients were followed up for 6-8 months. Endometriotic lesions improved or disappeared in most women; pain (dysmenorrhoea, dyspareunia and pelvic pain) subsided rapidly. Most women had no, or alleviated, symptoms throughout follow-up, although ovarian function resumed promptly. Nearly a quarter of infertile women with a desire for children became pregnant. No significant differences between treatments emerged. Buserelin treatment was characterized by menopausal-like symptoms in most women, as well as by headache and nausea. Danazol treatment, which also gave rise to these effects, was accompanied by weight gain, myalgia and acne in a considerable proportion of women, as well as other anabolic and androgenic side effects. Buserelin would thus appear to be a safe and effective alternative to the standard therapy, danazol, in the treatment of endometriosis.
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PMID:Efficacy and safety of intranasal buserelin acetate in the treatment of endometriosis: a review of six clinical trials and comparison with danazol. 210 46

The therapeutic efficacy of the new triphasic contraceptive agent trisistone was evaluated in 42 women (20-35 years old) with various gynecological diseases. The group included 25 with uterine hemorrhage, 4 with post-castration syndrome, 4 with endometriosis, 4 with hypogonadism, and 5 with other diseases. The drug was dispensed monthly. The patients received 1 to 14 packages of trisistone (average number 3-4). The first phase consisted of 6 violet tablets containing 0.003 mg of ethinyl estradiol and 0.05 mg of levonorgestrel; the second phase consisted 6 pink tablets containing 0.04mg of ethinyl estradiol and 0.075 mg of levonorgestrel and third phase consisted of 9 orange tablets containing 0.03 mg of ethinyl estradiol and 0.125 mg of levonorgestrel. Of 42 patients, 16 had stopped taking the drug after the first cycle, while 26 showed clinical improvement. The treatment was the most effective in patients with estrogen and gestagen insufficiency, luteal insufficiency, and primary ovarian dysgenesis. Side-effects of trisistone included hemorrhage (9.5%), headache (7.1%), sensation of pregnancy (7.1%), dizziness (2.4%), and nausea (2.4%).
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PMID:[The use of the triphasic contraceptive preparation trisiston for therapeutic purposes]. 237 4

Femigen forte (chlormadinone 3 mg + mestranol .1 mg) was administered to 90 women and Femigen mite (chlormadinone 2 mg + .084 mg of mestranol) was administered to 43 women, both groups aged 19-47 years, as a contraceptive and as therapy for endometriosis, dysmenorrhea, irregular and profuse menstruations, in the incipient phase of climax, and in diagnostics. Both drugs were observed to be 100% effective as contraceptives. Side effects such as nausea, intermenstrual bleedings, and absence of menstruation were most often observed with Femigen forte; about 30% of these users. Most side effects occurred in the first 2 cycles. Those using Femigen mite showed almost no side effects. No increase in the concentration of blood glucose was noted with either preparation. The effect of these drugs on the vaginal lining and on the endometrium was weak. No thromboembolic complications were observed. The low-dose preparation was recommended more for contraception. An estrogenic content of about .05 mg creates the same effect and decreases the occurrence of side effects.
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PMID:[Femigen forte and mite preparations in contraception and gynecologival disorders]. 409 77

While endometriosis is a commonly encountered surgical problem, involvement of the gastrointestinal tract is infrequent and appendiceal involvement rate. Intussusception of the appendix is more frequent. Accordingly, the concurrence of appendiceal endometriosis and intussusception is remarkable. We treated two such patients. The clinical presentation of these patients is varied, with most having abdominal pain, nausea and diarrhea. Asymptomatic cases may be found at surgery for unrelated problems. Correct diagnosis preoperatively is uncommon and most likely when the patients also have a palpable mass.
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PMID:Endometriosis associated with appendiceal intussusception. A report of two cases. 648 17

A review of the composition, usage, and side effects of hormonal contraceptives is presented. The estrogens ethinyl estradiol, mestranol, ethinyl estradiol sulfonate, and quinestrol, as well as the gestagens chlormadinon acetate, norethindrone acetate, and d-norgestrel, are used in combination, sequential, and depot preparations, mini-pills, and morning-after pills. The failure rate of combination preparations is 1/100 women-years and of sequential preparations is 1-5/100 woman-years. Gestagen-intensive preparations can be used for women showing symptoms of gestagen deficiency (e.g. hypermenorrhea, endometriosis), while estrogen-intensive preparations are indicated for women with e.g. hypomenorrhea, acne, or hirsuitism. Preparations containing chlormadinon acetate are indicated for women with signs of androgen imbalance or for women who sing or use their voices professionally. Control check-ups of patients using hormonal contraceptives should occur every 6 months. Women who still want to bear children should discontinue hormonal contraceptive use for a certain period every 2 years. Hormonal contraceptives can be prescribed to adolescents 2 years after menarche and after one year of regular menstruation. The side effects of hormonal contraceptive use are listed. Subjective side effects such as nausea and headaches are frequently reported. Hormonal contraceptives can cause menstrual irregularities; spottings or break-through bleedings during hormonal contraceptive use indicate a reduced contraceptive effectiveness. Hormonal contraceptive use causes increases in laboratory values, e.g. SGOT, SGPT; lipid metabolism and carbohydrate metabolism are also affected by hormonal contraceptives. Hormonal contraceptives have been shown to cause an increase in blood pressure and affect the circulatory system, liver and gall bladder function, and blood coagulation. Neoplasms may be affected positively or negatively by hormonal contraceptive use. Relative and absolute contraindications for hormonal contraceptive use as well as indications for discontinuing hormonal contraceptive use are listed.
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PMID:[Hormonal contraception--side effects and surgical aspects (author's transl)]. 701 44

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.
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PMID:[Treatment of endometriosis with the GnRH agonist leuprorelin acetate depot (Enatone-Gyn monthly depot): a multicenter study]. 784 80

Retention mucocele of the appendix is caused by a variety of obstructive lesions such as postinflammation, fecalith, carcinoid tumor, and endometriosis. Appendiceal mucocele due to endometriosis is extremely rare; only one documented case of such condition has been recorded in the literature. We describe a young black woman who had abdominal pain, nausea, and vomiting. Abdominal exploration revealed a small retention mucocele caused by endometriotic obstruction at the distal segment of the appendix. No evidence of endometriosis in other organs was found. The patient was asymptomatic after appendectomy.
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PMID:Retention mucocele of appendix due to endometriosis. 805 97


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