Agonist analogues of
LHRH are of potential value in the management of oestrogen-dependent conditions in women. However, their clinical effectiveness is a direct consequence of ovarian suppression which is in itself associated with adverse effects, in particular loss of bone mass. They are thus unsuitable for long-term use in premenopausal women with benign conditions but in future may have a wider role in combination with other agents. In women with
uterine fibroids,
therapy leads to reduction of uterine volume and alleviation of symptoms although the benefit is rapidly reversed when
therapy ceases. Although there is a theoretical potential for combined
therapy, successful combinations have yet to be identified. Thus, at the present time, agonists of
LHRH do not offer a true alternative to surgery for the majority of women. They will be of value where there is a contra-indication to surgery and for women approaching the age of the natural menopause. They may also be of use prior to surgery, both in controlling symptoms and in reducing surgical morbidity and blood loss.
LHRH agonists appear to be beneficial in the management of some women with severe
premenstrual tension but intensify symptoms in others. Particular care is required in selection of women for such
therapy because of the uncertain nature of the condition and its high rate of response to placebo
therapy. Response is dependent on the degree of ovarian suppression and long-term use of
LHRH agonists alone is clearly undesirable. However
LHRH agonists alone or in combination with ovarian
steroids are of potential value as a research tool. In premenopausal women with advanced
breast cancer, concerns about the long-term effects of
therapy with
LHRH agonists are less important and these drugs offer a medical alternative to
oophorectomy as first-line treatment in women with oestrogen receptor-positive tumours. Future developments are likely to include evaluation of combined
therapy and comparative studies in women with early disease. As such studies involve long-term treatment, they will generate very useful information about the effects of
therapy. This will be of great value to clinicians evaluating the role of
LHRH agonists in the management of benign conditions.