Q J Med 1990; 75: 355-363
© 1990 Association of Physicians
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LHRH Analogue Treatment for the Prevention of Premenstrual Attacks of Acute Porphyria
University Department of Medicine, Gardiner Institute, Western Infirmary Glasgow *Institute of Biochemistry, Glasgow Royal Infirmary Glasgow
Address correspondence to Dr K. E. L. McColl, Gardiner Institute, Western Infirmary, 44 Church Street, Glasgow GII 6NT.
Accepted for publication 18 September 1989.
We have assessed the value of suppressing ovulation with the luteinizing hormone releasing hormone (LHRH) analogue buserelin in seven patients experiencing crises of acute intermittent porphyria related to the menstrual cycle. Clinical course, plasma oestradiol and progesterone levels, and urinary porphyrin and precursor excretion were monitored over a baseline period of approximately one year, and then for a similar period on buserelin treatment. There was a trend towards clinical improvement on buserelin therapy. The median number of attacks fell from seven during the baseline period to three on treatment (p=0.06). The response to buserelin varied considerably, with those patients in whom the association between baseline attacks and the menstrual cycle was strongest gaining the most benefit. All patients became amenorrhoeie with suppression of plasma oestradiol and progesterone levels. Urinary 
aminolaevulinic acid and total porphyrin excretion fluctuated widely both before and during treatment. Our experience indicates that ovulation suppression may be of value in the management of young women in whom recurrent attacks of porphyria are related to the menstrual cycle.