Leuprorelin Acetate

How it works

Continuous leuprorelin exposure initially stimulates then desensitises pituitary GnRH receptors, causing downregulation of gonadotrophin release and a profound fall in ovarian oestrogen production.

Prescribing in practice

• The hypo-oestrogenic state causes loss of bone mineral density with prolonged use, so duration is limited and add-back hormonal therapy is often used for longer courses.
• An initial flare of hormone levels can transiently worsen symptoms before suppression is achieved.
• Menopausal effects such as hot flushes, vaginal dryness and mood changes are common during treatment.

Monitoring

Consider bone density assessment with extended or repeated courses, and review symptom control and menopausal side effects during treatment.

Counselling the patient

• Symptoms may briefly worsen in the first weeks before improving.
• Expect menopause-like effects such as hot flushes while on treatment.
• Use non-hormonal contraception if advised, as this is not a contraceptive.

Evidence & guidelines

NICE guidance and the SPC support GnRH agonists such as leuprorelin for endometriosis and fibroids, with attention to bone health and the use of add-back therapy for longer treatment.