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The Antigonadotropic Activity of a 19-Nor-Progesterone Derivative Is Exerted Both at the Hypothalamic and Pituitary Levels in Women

Service d’Endocrinologie et des maladies de la Reproduction et Laboratoire de Biochimie Hormonale, Hopital Bicetre, 94275 Le Kremlin Bicêtre, France; and Laboratoire de Neuropathologie, Hopital Pitié-Salpetrière, 75013 Paris, France

Address correspondence and requests for reprints to: Gilbert Schaison, M.D., Service d’Endocrinologie et des maladies de la Reproduction, Hopital Bicêtre, 94275 Kremlin Bicêtre Cedex, France. E-mail: gilbert.schaison{at}bct.ap-hop-paris.fr

We have previously shown in postmenopausal women that a 19-nor-progesterone derivative, nomegestrol acetate (NOMA) had a strong antigonadotropic activity and that this effect was not mediated via the androgen receptor. The aim of the present study was to further assess the action of this progestin on gonadotropin secretion in women. To demonstrate at which level of the hypothalamo-pituitary-ovarian axis the gonadotropin inhibition was exerted, 10 normally cycling (NC) women, 3 women with a gonadotropin-independent ovarian function [McCune-Albright (MCA) syndrome], and 5 women with functional hypothalamic amenorrhea (FHA) participated in the study.

NC women were treated orally with 5 mg NOMA for 21 days, after one control cycle. Plasma estradiol (E₂) and progesterone, LH, and FSH levels were measured during each cycle. A frequent sampling study (every 10 min for 4 h), followed by a classic GnRH test (100 µg, iv), was performed on day 11. Women with MCA were studied before, during NOMA, and after long-acting GnRH agonist administration. In women with FHA, pulsatile GnRH (20 µg sc, every 90 min) was given for two cycles with or without NOMA (5 mg for 21 days).

In all NC women, ovulation was suppressed by NOMA. Mean plasma LH levels, LH pulse frequency, and the LH response to exogenous GnRH were significantly decreased. In MCA, neither NOMA nor GnRH agonist modified multiple ovarian cysts on ultrasound or plasma E₂, levels which remained elevated, ruling out a direct ovarian effect. In FHA, pulsatile GnRH administration recreated a normal ovulatory menstrual cycle. Addition of NOMA prevented the increase of plasma E₂, decreased the amplitude of LH pulses, and prevented ovulation. In view of this unexpected action of NOMA at the pituitary level, seven samples of normal human female pituitaries were tested for the presence of progesterone receptor (PR) using a double labeling immunocytochemical technique. The presence of PR was detected in the seven human pituitary tissues. In addition, PR was found to be expressed only in gonadotroph cells.

In conclusion, NOMA, a 19-nor-P derivative, has a potent antigonadotropic activity exerted at the hypothalamic level, inhibiting ovulation in NC women. In women with FHA, NOMA decreased the gonadotropin stimulation induced by pulsatile GnRH administration. According to the presence of PR in gonadotroph cells of normal human pituitaries, 19-nor-progesterone derivatives may also act on the gonadotropin secretion at the pituitary level.

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