Differential effect of gonadotropin-releasing hormone analogue treatment on estrogen levels and sulfatase activity in uterine leiomyoma and myometrium.

OBJECTIVE

To investigate the effect of GnRH treatment on estrogen levels and sulfatase activity in leiomyoma and myometrium tissue.

DESIGN

Retrospective analyses of tissue obtained in a prospective randomized clinical study.

SETTING

Gynecology departments of eight hospitals in the Netherlands.

PATIENT(S): Thirty-two patients scheduled for leiomyoma surgery.

INTERVENTION(S): Patients were randomized to receive either GnRHa (3.75 mg/4 weeks of triptorelin or 3.6 mg/4 weeks of goserelin) or no GnRHa for 4 months. At subsequent surgery, leiomyoma and myometrium samples were collected.

MAIN OUTCOME MEASURE(S): Estrone, estradiol, and sulfatase activity levels in leiomyoma and myometrium.

RESULT(S): In myometrium, levels of estrone, estradiol, and sulfatase activity were significantly lower in the treated group (to median values of 46%, 21%, and 61%, respectively). In leiomyomas of treated patients, the reduction in median estrone level (to 65% of untreated value) was comparable to that in myometrium. The reduction in estradiol level in leiomyoma, however, was significantly less than in myometrium (median to 58% vs. 21%), and no significantly lower sulfatase activity was found.

CONCLUSION(S): Estradiol and sulfatase results show that the effect of GnRHa treatment on leiomyoma differs from the effect on myometrium, suggesting a continuing estrogenic stimulus in leiomyoma tissue despite treatment.