The use of an anterior pituitary luteinizing substance in the treatment of functional uterine bleeding

Abstract The present report deals with the treatment of 51 cases of functional uterine hemorrhage by an anterior pituitary luteinizing principle derived from the urine of pregnant women. In 44 of these the treatment was successful in checking the bleeding, even though some of our patients were treated with preparations of somewhat uncertain luteinizing potency. Most of the failures were in this group. Previous efforts at the organotherapy of this condition have been unsuccessful. Radiotherapy is very undesirable in young women, so that, because of the frequent intractability of functional hemorrhage, many patients have had to submit to repeated curettage. The characteristic ovarian finding in these cases is an absence of corpora lutea. The administration of progestin, if this were available, would be a rational plan of treatment. Progestin is not yet available for human administration, and its effects would, moreover, be purely substitutional, as it has no effect on the ovaries. The administration of the luteinizing hormone of the anterior pituitary (prolan B) can be expected to be more fundamental in its effects. This substance has been shown by laboratory studies to produce striking luteinization in the ovary, and the secretion of the lutein cells is progestin, the element lacking in functional hemorrhage. The hormone can be obtained from the urine of pregnant women, although its extraction is as yet somewhat difficult, and the preparations with which we have worked have been of very variable potency. With strongly luteinizing preparations, it has been possible to check functional hemorrhage in 27 of 29 cases. In 14 of our 51 cases the bleeding has ceased after a single injection, and in 12 after two injections. A large proportion of these cases were of the intractable and recurrent type, many having had from one to four or more curettements. With less potent luteinizing preparations, the results have been less impressive, but on the whole satisfactory. Our experience with the entire group has convinced us of the value of the treatment in functional hemorrhages, and of its even greater future possibilities. This opinion seems a compelling one even though, in the nature of things, the results cannot be controlled with the precision of laboratory experiments. The rapidity of the effect in many cases makes it seem certain that the immediate effect, at least, is not brought about through the production of lutein tissue and progestin by the ovary. We believe that this immediate effect is exerted upon the still unknown bleeding factor which is the immediate cause of the bleeding in functional hemorrhage, and which is influenced by far smaller dosage than would be required to produce histologic changes in the ovary. This view we base upon recent investigations on this bleeding factor and on studies upon the relative dosage required to bring about the various stages of estrus. These are discussed in the paper. It is hoped that improvements in results will come with improvements in the methods of preparation of this substance, and, quite possibly, in its preparation in water-soluble solid form. Whether the intravenous method of administering prolan will yield results more favorable than the intramuscular route remains to be seen.