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Then, an additional dose of HMG 3 x (75-150 IU FSH + 75-150 IU LH)/week is administered IM for a few months. Females: Pregnancy, enlargement of the ovaries or cysts that is not caused by polycystic ovarian syndrome, gynaecological bleeding of unknown cause and tumors in the uterus, ovaries and breasts. Males: Carcinoma of the prostate and tumors in the testes. The following conditions must be properly treated before therapy with HMG is begun: Dysfunctions of the thyroid gland and of the cortex of the suprarenal gland, a rise in the serum level of prolactin with different causes (hyperprolactinaemia), tumors in the pituitary gland (hypophysis) or in part of the diencephalon (hypothalamus). When treating sterile women, ovarian activity should be checked (ultrasound and estradiol levels in serum response) prior to HMG administration. During treatment, these tests should be carried out every 1-2 days until stimulation occurs. Ovarian reaction can also be measured using a cervix index. Close supervision is imperative during treatment. Treatment should be immediately discontinued if unintentional hyperstimulation occurs. Further remarks concerning the steps to be taken when ovarian hyperstimulation has occurred can be found under Actions. Drug Side Effects :: Occasionally, nausea and vomiting can occur. In single cases, hypersensitivity reactions and fever can occur during treatment with HMG. The administration of Menogon may lead to reactions at the injection site: Reddening, pain, swelling and itching, anadrol 50 mg oral steroids anadrol, oxy. In very rare cases, long-term usage can lead to the formation of antibodies, making the therapy ineffective. Treatment with HMG can often lead to ovarian hyperstimulation that first becomes clinically relevant after the administration of hCG (pregnancy hormone) to induce ovulation. This can lead to the formation of large ovarian cysts that tend to rupture and to intra-abdominal bleeding. In addition, the accumulation of fluids in the abdominal cavity (ascites), the accumulation of fluids in the chest cavity (hydrothorax), a decrease in the excretion of urine (oliguria), lowering of the blood pressure (hypotension), and occlusion of blood vessels by blood clots (thromboembolic phenomena) can occur. Treatment should be immediately discontinued when the first signs of hyperstimulation appear: Abdominal pain and a palpable (by the physician) enlargement in the lower abdomen, which can be detected sonographically. If abdominal pain occurs, see the doctor. With pregnancy, these side effects can intensify, continue over a long period of time, and be life threatening. Unintentional multiple pregnancies occur more often during treatment with HMG. Drug Mode of Action :: Menotrophins, a purified extract of human post-menopausal urine, contain follicle-stimulating hormone (FSH) and luteinising hormone (LH) in a ratio of 1:1. The biological effectiveness of menotrophins is mainly due to its FSH content. In the ovaries, the FSH-component increases the quantity of growing follicles and stimulates their development. Under the influence of LH, FSH increases oestradiol production in the granulosa cells.
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