Endometriosis: The Effects, Side effects and Risk factors of GnRH agonists

Posted by Chantel Martiromo, Research article by Kyle J. Norton


During the last stage of the menstrual cycle, normally a layer of endometriosis lining on the inside of the uterus is expelled, known as menstruation blood, instead some of the endometriosis tissues grow somewhere in the body to cause endometriosis. Endometriosis also react to hormone signals of the monthly menstrual cycle, by building and breaking up tissues and eliminating them through menstrual period.

GnRH is a hormone released by the hypothalamus which stimulates the pituitary to produce luteinising hormones (LH) and follicle that stimulate hormone (FSH) to drive a menstrual cycle.
1. Effectiveness of GnRH
Just likes progesterone-like agonists, GnRH ( gonadotrophin-releasing hormone) have been used in treating endometriosis for more than 20 years. They come in different forms: three-monthly injection, monthly injection, daily injection and nasal spray because of their chemical make up. GnRH are natural hormone blocking medicines, they help to stop the ovulation(283) and create a temporary menopause state(283).
Study shows that GnRH are effective in reducing the symptoms such as pain and infertility. Dysmenorrhoea, deep dyspareunia, dyschezia and dysuria(282) and the size of endometrial implants(282) but unfortunately, symptoms tend to return(284) after stopping treatment in 4 months.

2. Side effects
a) Hot flush, interruption of sleep (285), dry vagina(286), sweating(286), caused by temporary of menopause state.
b) Nutritional deficiency(288) caused by symptoms of menopause state as our body is no longer absorb magnesium and calcium effectively.
ce) Bleeding (spotting, break-through bleeding, menstruation)(286)

3. Risks
1. Loss of bone density(287)
Loss of bone density is normal for women taking the GnRH drug. Since it causes menopause state, it deplete the calcium in the body that is essential for building a healthy bone. It also distorts the ratio of magnesium and calcium.
2) Reducing sexual desire(286)
Sexual libido may be caused by dry vagina, one of many symptoms of GnRH. It may also be caused by low level of estrogen that is essential for driving sexual desire.
3) Increase the risk of ectopic pregnancy(289).
4) Diminished ovarian reserve(290).

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References
(282) Endometriosis: pathogenesis and treatment by Vercellini P1, Viganò P2, Somigliana E1, Fedele L1.(PubMed)
(283) Endometriosis: an overview of Cochrane Reviews by Brown J1, Farquhar C.(PubMed)
(284) Effects of laparoscopic ovarian endometriosis cystectomy combined with postoperative GnRH-a therapy on ovarian reserve, pregnancy, and outcomerecurrence by Yang XH, Ji F, AiLi A, TuerXun H, He Y, Ding Y.(PubMed)
(285) A gonadotropin-releasing hormone agonist model demonstrates that nocturnal hot flashes interrupt objective sleep by Joffe H1, Crawford S, Economou N, Kim S, Regan S, Hall JE, White D.(PubMed)
(286) [Ovarian suppression by the GnRH analog buserelin in the treatment of endometriosis. Clinical, biochemical and pelviscopic studies].[Article in German] by Raitz von Frentz M1, Schweppe KW.(PubMed)
(286) [A meta-analysis of preventing bone mineral loss in patients with endometriosis treated by gonadotrophin-releasing hormone analogues with add-back therapy].[Article in Chinese] by Niu ZR1, Yue XJ, Kong QY, Wang YF, Yao YQ.(PubMed)
(288) Effect of an aproteic diet on gonadotropin release response to GnRH and estrogen-progesterone in rats. by Ponzo OJ1, Rondina D, Szwarcfarb B, Carbone S, Moguilevsky JA, Scacchi P.(PubMed)

(289) The risk of ectopic pregnancy following GnRH agonist triggering compared with hCG triggering in GnRH antagonist ivf cycles by Sahin S1, Ozay A, Ergin E, Turkgeldi L, Kürüm E, Ozornek H.(PubMed)
(290) Diminished ovarian reserve is the predominant risk factor forgonadotropin-releasing hormone antagonist failure resulting in breakthrough luteinizing hormone surges in in vitro fertilization cycles by Reichman DE1, Zakarin L2, Chao K1, Meyer L1, Davis OK1, Rosenwaks Z3.(PubMed)