As symptoms progress, more aggressive methods, such as ovulation suppression, may be indicated. An injection of a gonadotropin-releasing hormone agonist (such as buserelin or leuprolide) may be used
2-5,7,8,12,17 and often provides immediate relief with cessation of the progesterone peaks. However, treatment with these agents is limited because of concerns for premature menopause and relative osteoporosis.
12 Treatment with danazol has been shown to effectively reduce symptoms of AIPD
6,8,10,12,17 and prophylactically reduce outbreaks by means of altering immune complex–induced vasculitic reactions.
18 In addition, Stephens et al,
19 among others, suggest the use of tamoxifen for reducing the severity of AIPD.
3,6-8,11,12,17 The latter 2 methods have a high incidence of adverse effects, particularly tamoxifen’s effect on menopausal symptoms and danazol’s antiestrogenic effect on bone metabolism.
2,17 These drugs are not recommended for long-term use.
11 A less aggressive, reversible suppression may be accomplished using low- or medium-dose oral contraceptives.
3-5,7,8,12 Although synthetic progestins may be linked to the causation of the sensitivity, a suppressive progestin (such as the norethindrone, given in case 3) or combined oral contraceptive may also be successful in suppressing the symptoms caused by the monthly endogenous progesterone surge, as long as no cross-reacting antibodies to synthetic progesterone exist.
3 Until sensitivity to progestins is determined, suppression of ovulation with long-term progesterone analogs (such as medroxyprogesterone) should be avoided, because this form is not reversible and could cause detrimental effects. Likewise, some reports suggest using conjugated estrogens alone if the patient does not require progesterone balancing, as in women who have undergone a hysterectomy.
2-5,7,9