Gonadotropin-releasing hormone agonists: emerging modification of treatment regimens

GnRH agonist (GnRHa) medications are now routinely used by gynecologists, urologists, medical endocrinologists, and pediatric endocrinologists alike. GnRHa are frequently highly effective in diminishing pain derived from endometriotic lesions. Current US Food and Drug Administration approval limits GnRHa regimens to a 6-month course largely because of concern that the hypoestrogenic state invoked by the medication can lead to loss of bone mineral density. Most studies on this issue show either a very small diminution of bone density over this interval or no detectable changes. The role of GnRHa in shrinking uterine fibroids and/or diminishing bleeding, both before and during surgery is much more an adjunctive-to-definitive surgical intervention than a free-standing medical therapy. Attempts to suppress with GnRHa and co-administer estrogens with progestins or progestins alone, either concurrently or sequentially (delayed), are now being studied vigorously. The place of GnRHa in medical management of a variety of endocrine conditions is no the standard of care.