Læknablaðið - 15.01.1987, Side 45

LÆKNABLAÐIÐ
29
NÝR DOKTOR í LÆKNISFRÆÐI
JENS A. GUÐMUNDSSON
Jens A. Guðmundsson
Þann 23. maí 1986 varði Jens A. Guðmundsson
doktorsritgerð sína við Akademiska Sjukhuset í
Uppsölum. Ritgerðin ber nafnið »Peptide
Contraception in Women« og fylgir útdráttur úr
henni hér á eftir:
In women, ovulation can paradoxically be
inhibited by daily intranasal administration of
stimulatory analogues to the hypothalamic
gonadotrophin-releasing hormone (GnRH).
Forty-seven women used a new highly potent
GnRH agonist, D-Nal(2)6-GnRH (nafarelin), for
contraception during six months. The' daily doses
of nafarelin were 125 pg (n = 25) or 250 pg
(n = 22).
Ovulation was inhibited during 261 of 262
treatment months and no pregnancy occurred.
The predominant bleeding pattern was
oligomenorrhea or amenorrhea. Vasomotor hot
flushes were reported by 19 women. Thirtyeight
women continued the therapy for six months. The
plasma estradiol levels varied within the range for
the early follicular phase of the normal menstrual
cycle. The mean estradiol level during the last
month of treatment was 162 (SE, 48) pmol/1. The
effects of treatment were rapidly reversible.
Endometrial biopsies displayed an inactive or
weakly proliferative pattern. No case of
endometrial hyperplasia was found.
HDL-cholesterol increased and
HDL-triglycerides decreased in serum during the
therapy. Increases in serum triglycerides and
apolipoprotein B occurred only in the women
who smoked. The small lipid changes probably do
not entail altered risk for ischemic heart disease.
Fasting serum calcium and urinary
calcium/creatinine ratio increased in both
smokers and non-smokers. Furthermore, serum
phosphate and osteocalcin increased and serum
parathyroid hormone decreased in non-smokers.
These changes, which indicate increased bone
resorption and turnover, were not evident in
women who retained mean plasma oestradiol
levels above 200 pmol/1 during the therapy.
To conclude, daily intranasal GnRH agonist
treatment proved to be an effective and rapidly
reversible method for contraception. Possible
adverse effects on bone metabolism have to be
further evaluated during future development of
this new contraceptive method.