[Contraception by cyclic treatment with buserelin and progesterone]

Area of Science:

• Reproductive Endocrinology
• Pharmacology

Context:

• Hormonal contraception is crucial for women with contraindications to traditional methods.
• High-risk patients with cardiovascular diseases, thromboembolic complications, or other severe conditions often lack safe oral contraceptive options.

Purpose:

• To evaluate the efficacy and safety of a novel hormonal contraceptive regimen combining a gonadotropin-releasing hormone agonist (GnRH-agonist, Buserelin) with progesterone.
• To assess the feasibility of this regimen in patients with contraindications to oral contraceptives.

Summary:

• A combination of intranasal Buserelin (GnRH-agonist) and intravaginal progesterone was administered daily to 47 high-risk patients over 547 cycles.
• This regimen maintained average estradiol (E2) concentrations between 50-60 pg/ml, indicating preserved follicular maturation and estrogen production.
• Cycle control was acceptable, with withdrawal bleeding upon progesterone discontinuation. Four cases required discontinuation due to side effects, and one patient conceived.

Impact:

• This GnRH-analogue based contraception demonstrates potential for ovulation inhibition without complete suppression of follicular activity and estrogen production.
• The findings suggest a new contraceptive strategy for women with contraindications to oral contraceptives, though it necessitates careful patient selection and monitoring due to cost and potential side effects.