Depo lupron and premature puberty: Are there any other treatments?

Originally Published: February 3, 2006
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Dear Alice,

My question is about my daughter. When she was 7-years-old, she started puberty. She is diagnosed with Central Precocious Puberty. She takes a monthly shot of depo lupron. Is there an alternative to this shot???

Dear Reader,

Central Precocious Puberty (CPP)[j1]  is a condition where children begin puberty early – typically before the age of 8 years for girls and before the age of 9-½ years for boys.  CPP is more common in girls than in boys.  Children with CPP generally show normal signs of puberty, including increased growth rate and development of pubic hair.  Some studies suggest that 1 in 10,000 children in the United States begin puberty prematurely.  The causes of CPP are not always known, especially in girls.  CPP can occur in response to diseases of the central nervous system, brain injuries or infections, tumors, cysts, or seizure disorders.  In boys, CPP is often caused by brain tumors.   

You mention that your daughter takes Depo Lupron.  Depo Lupron is a medication that delays the progression of puberty by inhibiting the release of a hormone called Gonadotropin Releasing Hormone (GnRH).  GnRH is a chemical that affects the development and function of the ovaries  and testicles.  Children  with CPP usually take Lupron via injection until they reach a normal age of puberty.  Once Lupron injections are stopped, normal puberty functions begin again within a few weeks to a few months.

Side effects of Lupron can include pain, burning, itching, and redness or swelling at the site of injection.  In girls, some rare cases may experience vaginal bleeding or a white vaginal discharge.  After several weeks of treatment, girls may experience side effects similar to those associated with menopause, including:
  • hot flashes
  • vaginal dryness
  • insomnia

Long-term use of Lupron also can cause a decrease in bone density, so girls who take Lupron are encouraged to take calcium supplements daily.  Sometimes, small amounts of the female hormone estrogen can also help alleviate side effects.

Alternatives to Lupron include the drugs Supprelin and Synarel.  These synthetic hormones function similarly to Lupron by limiting the production of chemicals that cause puberty.  Although Supprelin is administered by injection, Synarel is taken as a nasal spray.  One common side effect of these medications is light vaginal bleeding for girls, though this usually disappears after the first month.

If you're concerned that Lupron might not be the right medication for your daughter, your health care provider can help you decide if Supprelin or Synarel would be a more appropriate treatment.  You don't mention exactly why you might want to change your daughter's medication – perhaps you can address your specific concerns with your health care provider or your endocrinologist.  Perhaps your daughter's plan of treatment could be changed accordingly.  Lastly, getting a second opinion may help to provide a fresh perspective on the available options. 

Alice