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Comparison between the effects of nafarelin and danazol on serum lipids and lipoproteins in patients with endometriosis.

The effects of nafarelin (400 micrograms daily; 12 patients) and danazol (600 mg daily; 6 patients) on serum lipoproteins, high density lipoprotein (HDL) subfractions, and apoproteins-A-I and -A-II were studied. Lipoproteins were fractionated by sequential flotation from samples taken before and after 1, 3, and 6 months of treatment as well as 3 months after cessation of medication. Serum concentrations of estradiol, total and free testosterone, androstenedione, and sex hormone-binding globulin were also determined. On nafarelin treatment, serum total HDL and HDL2 cholesterol concentrations increased slightly, but total and low density lipoprotein (LDL) cholesterol levels were unchanged. There was no effect on apoproteins-A-I and -A-II or on total and very low density lipoprotein (VLDL) triglyceride concentrations. During treatment with danazol, the serum levels of total HDL and HDL2 cholesterol showed profound decrease, as did all the components of HDL2, including apoprotein-A-I. Concomitantly, the total mass of LDL was increased by 25%, accounted for by parallel rises in all of the components of LDL. Total and VLDL triglyceride concentrations decreased inconsistently. Both treatments resulted in hypoestrogenism of the same degree. The steep drop in the serum sex hormone-binding globulin level reflected the androgenic effect of danazol, whereas during nafarelin treatment, serum concentrations of testosterone and androstenedione were reduced. This difference in androgenic milieu may well explain the differences in the lipid profiles. We conclude that, regarding lipid effects, nafarelin is a more favorable treatment for endometriosis than is danazol.