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Suppression of Pituitary Gonadotropins and Ovarian Steroids in Women with Polycystic Ovarian Disease Using Intranasal Nafarelin Acetate
Author(s) -
FRACOG Ian S. Fraser,
FRACOG Robert P.S. Jansen,
Sutherland Paul D.,
Shearman Rodney P.
Publication year - 1994
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1994.tb01120.x
Subject(s) - medicine , endocrinology , prolactin , testosterone (patch) , polycystic ovarian disease , endocrine system , luteinizing hormone , follicle stimulating hormone , gonadotropin , hormone , polycystic ovary , insulin , insulin resistance
Summary: Nineteen women with polycystic ovarian disease confirmed by laparoscopy or ultrasound were treated with intranasal nafarelin in the relatively high dosage of 400 μg twice daily for 40 days to suppress pituitary and ovarian function. Changes in endocrine response were assessed by blood sampling 5 times in the first week and then 3 times weekly. Serum levels of LH, FSH and oestradiol (E 2 ) were measured in each sample, progesterone (P), prolactin (PRL) and total testosterone (T) once weekly, and free testosterone once monthly. There were dramatic rises within 24 hours in serum levels of FSH (more than doubled), LH (more than quadrupled) and E 2 (more than trebled), and steady declines thereafter. FSH fell into the pretreatment range most quickly (3–4 days), LH more slowly (4–14 days) and E 2 slowest (8–14 days). Levels of FSH and E 2 reached a plateau within 7–21 days, while LH continued to decline throughout the 40 days. Hence, the LH/FSH ratio declined steadily from a mean of 2.0 before therapy, reversed by day 21 and reached a mean of 0.55 by day 40. Serum E 2 was only suppressed to a mean of 150 pmol/L and in 4 women only occasionally suppressed below 200 pmoI/L. There was a small rise in total and free testosterone within the first 1–2 weeks, followed by gradual suppression by day 28 of total T (from 3 to 2 nmol/L) and free T (from 120 to 50 pmol/L). In 5 individuals free T was never suppressed into the normal range. PRL remained unchanged and P remained low. This study has demonstrated that LH continues to show a progressive fall over at least 40 days in women with PCO treated with a high dose intranasal GnRH agonist, yet steroid secretion of E 2 and T from ovaries and other sources often remained surprisingly high. It seems unlikely that long‐term GnRH agonist therapy on its own will have much of a role in the management of polycystic ovarian disease.