Treatment of endometriosis with goserelin depot, a long-acting gonadotropin-releasing hormone agonist analog: endocrine and clinical results.

Thirty-two patients with laparoscopic diagnosis of endometriosis were treated for 6 months with the gonadotropin-releasing hormone agonist goserelin depot. Hormonal and clinical evaluations were conducted during treatment and for a 6-month follow-up period. Serum 17 beta-estradiol levels were sharply suppressed. Luteinizing hormone was also decreased, whereas follicle-stimulating hormone, after an initial fall, gradually rose to pretreatment levels. Ovarian androgenic production was less inhibited, total testosterone being the only significantly suppressed hormone. There was a marked improvement of signs and symptoms of endometriosis and a 47.3% reduction of laparoscopic score. The results of this study suggest that goserelin depot provides a very good suppression of ovarian estrogen production and is highly effective in decreasing the symptoms of endometriosis with an acceptable compliance by the patient.

Use of hysterosonography in women with abnormal postmenopausal bleeding.

PURPOSE OF INVESTIGATION: Hysterosonography (HS) allows evaluation of the endometrial cavity by endouterine administration of sterile physiologic solution. We aimed to identify the role of HS and transvaginal ultrasonography (TU) in postmenopausal women with unexplained bleeding in order to avoid further invasive investigation for patients with atrophic endometrium, and to obtain significant information on intracavitary focal lesions. METHODS: Eighty postmenopausal women with unexplained metrorrhage underwent both TU and HS. They were subsequently referred for hysteroscopy or dilatation and curettage, and histology was obtained. RESULTS: The sensibility of TU was comparable with that of HS (90% vs 93%). However, the specificity of TU was only 30%. Combined use of TU and HS raised sensibility and specificity to 95.9% and 96.7%, respectively. CONCLUSION: HS is superior to TU in the diagnosis of focal lesions because the uterine cavity, lesion volume and margins, and associated diffuse endometrial alterations are adequately depicted. HS is particularly valuable with benign focal lesions associated with atrophic endometrium, as in patients under tamoxifen in whom TU fails to detect the uterine cavity.

Immunohistochemical localization of epidermal growth factor receptor in leiomyomas from women treated with goserelin depot.

Epidermal growth factor receptors (EGFr) were studied by immunohistochemistry in human myometrium and leiomyomas from women treated with the GnRH agonist (GnRH-a) goserelin. The results were compared with those obtained from women not treated. Vessel cells of leiomyomas and myometrium were always more immunoreactive than fibrocytes and myocites. In fibroids from treated patients the histochemical score (HSCORE) of vessel cells was always significantly lower (p less than 0.001) than in control patients. Our data confirm a role of EGF also in fibroid growth and suggest that, the blood supply reduction associated with the volume reduction of these tumours, consequent to the GnRH-a treatment, could be EGF mediated.