The three GnRH agonists commonly used in clinical practice are:. Leuprolide and goserelin are administered by injection in doses for every 4 weeks or 12 weeks while nafarelin is administered by a nasal spray times daily. Because GnRH agonists temporarily turn off your ovaries production of estrogen and progesterone this class of medications is used to treat certain conditions in women that are estrogen and progesterone dependent.
These include:. There is also some evidence to suggest that GnRH agonists may also help preserve ovarian function in women undergoing chemotherapy for breast cancer.
These medications are very effective treatment options. Unfortunately, they have some significant side effects. Because they suppress your ovaries production of hormones, the side effects of GnRH agonists mimic the symptoms of menopause.
These side effects include:. To prevent the loss of bone associated with GnRH treatment your healthcare provider will likely prescribe a progestin or a combination of estrogen and a progestin. This is known as add-back therapy and it has been shown to be effective in preventing the bone loss associated with extended use of GnRH agonists. It also may help reduce the severity of the hot flashes as well. Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life.
Ohlsson B. Front Endocrinol Lausanne. Magon N. Gonadotropin releasing hormone agonists: Expanding vistas. Indian J Endocrinol Metab. Food and Drug Administration. Lupron Depot. This hormone is released by the hypothalamus in the brain.
GnRH acts on receptors in the anterior pituitary gland. FSH and LH then act on the ovaries in women and on the testes in men. They trigger the ovaries to mature and ovulate eggs, and, in men, trigger the testes to mature and produce sperm. FSH and LH also stimulate the ovaries and testes to release their own hormones. GnRH is released in pulses and not continuously. In men, these pulses come at a pretty consistent rate. In women, the frequency of the pulses varies depending on where the body is in the menstrual cycle.
For example, just before ovulation , the GnRH pulses are more frequent. Gonadorelin is a medication that acts like the hormone GnRH in the body. Testing usually involves receiving injections of this hormone at a specific interval. Then, at a specific time, injection of gonadorelin just below the skin into the fatty tissue. This procedure — injection followed by blood draw — will be continued. The results will then be analyzed in a lab. The test may be done in children with delayed puberty or adults with suspected hormonal imbalances.
Treatment With Gonadorelin via Lutrepulse Pump. Women who are not ovulating may be treated with gonadorelin via a Lutrepulse pump. This is done if a lack of GnRH is the cause for anovulation. Men who are not producing sperm may also be treated with a Lutrepulse pump. The pump delivers a measured dose every 90 minutes over a period of weeks. After treatment starts, in women, it usually takes two to three weeks for ovulation to occur.
After ovulation, treatment usually continues for another two weeks through the luteal phase. During IVF treatment , your fertility doctor needs to control the ovulatory cycle.
Most women will experience hot flushes or night sweats or both. The other common side effects are:. Bone thinning The most serious side effect of treatment with a GnRH agonist is thinning of the bones, particularly the bones of the spine. The matrix that makes up our bones is constantly breaking down and regenerating.
When the levels of oestrogen in the body are low, the rate of breakdown becomes greater than the rate of regeneration, so the bone matrix becomes less dense or thinner. It is thought that most of the bone lost during treatment regenerates within 6 months of completing treatment, and that 18—24 months after completing treatment probably most, if not all, the lost bone has been replaced.
Therefore, a single 6 month course of treatment will not usually be detrimental for women with normal bone density. However, in women at risk of developing the condition, treatment with a GnRH agonist could predispose them to developing osteoporosis. Osteoporosis fragile bones is a serious condition that can severely affect quality of life. In its more severe form, the bones, especially the bones of the spine and hips, break spontaneously.
In its less severe form, the bones may just be more prone to breaking. Most of us develop some degree of osteoporosis after menopause, so it is important that we lose as little bone density as possible before menopause. The most important risk factor for osteoporosis is a history of the disease in a close relative, such as a grandmother or mother. If you may be at risk of developing osteoporosis, you should consider having a bone density scan before embarking on treatment. Benefits of add-back therapy Add-back therapy can reduce the menopausal-type side effects of GnRH agonist therapy, which can make life more tolerable while on treatment.
More importantly, it may have long-term benefits by preventing or minimising the thinning of the bones associated with treatment with a GnRH agonist alone.
Others A few women will experience irritation of the nose if using a buserelin or nafarelin spray pump, or bruising and irritation of the skin around the injection site if using goserelin, leuprorelin or triptorelin injections. All the GnRH agonists work in the same way, so they are equally effective in regressing endometrial implants and reducing pelvic pain symptoms [1].
They appear to be at least as effective as progestins in relieving pain [6]. Use before surgery GnRH agonists should not be used before surgery to reduce the extent of peritoneal superficial implants disease.
Reducing the number and size of implants can make surgery more difficult by making it harder for the surgeon to see where the disease is present [1]. Treatment with a GnRH agonist before surgery may reduce the likelihood of ovarian endometriomas recurring [7], but the evidence is controversial [8].
Use after surgery Six months of GnRH agonist therapy immediately following surgery reduces the rate of symptom recurrence [9], and increases the length of time before symptoms recur [1].
It is also more effective in managing endometriosis-related pain after surgery than using oral contraceptives in the same way [10]. The benefits may be particularly relevant for women with active peritoneal disease [1]. Use in recurrent endometriosis If you have recurrent disease, you may be able to have further courses of GnRH agonist treatment, but the dosage and length of time between courses needs to be carefully considered to minimise the likelihood of losing bone density in the long term [11].
Thinning of the bones may be less marked during a second course of treatment compared with the first [11]. In addition, add-back therapy may reduce the risk of bone thinning, and make repeated, intermittent or even continuous treatment possible for up to 2 years [1].
The GnRH agonists — like all the hormonal treatments for endometriosis — do not improve your chances of conceiving, without any reproductive techniques, so they should not be used as a treatment for infertility.
You should see your gynaecologist about 6—8 weeks after beginning your course of a GnRH agonist to discuss how the treatment is progressing. GnRH agonists should not be used during pregnancy. GnRH agonists are found in small amounts in breast milk, so they should not be used while breastfeeding. GnRH agonists may interact with other medicines. Let your doctor know about any medication you are taking, including non-prescribed drugs such as complimentary therapies or herbal medicine.
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They are modified versions of a naturally occurring hormone known as gonadotropin releasing hormone, which helps to control the menstrual cycle. All the GnRH agonists are very similar chemically, but they come in different forms: three-monthly injection monthly injection daily injection nasal spray The names, forms and recommended dosages of the GnRH agonists used for endometriosis are shown in the table below.
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